Icebergs and ice cubes – the value of discussing stuttering with children and teenagers

About the authors:

linklaterJonathon Linklater, a Speech and Language Therapist in Ireland, stutters himself. Dedicated to a specialization in fluency disorders, he established an intensive therapy program called the Dublin Adult Stuttering (DAS) course in 2005. Jonathon re-established the Stuttering Special Interest Group for SLTs in Ireland in 2004, and co-founded the private practice SpeechMatters.ie in Dublin, Ireland, in 2011. He is Chair of the Irish Association of Speech and Language Therapists. He has been involved with the Irish Stammering Association since 2003 and is currently the Development Director for the charity. Since completing the European Clinical Specialism in Fluency Disorders in 2009, Jonathon has been undertaking a PhD at the University of Limerick, with guidance from Trinity College Dublin’s School of Clinical Speech and Language Studies.
lynchVeronica Lynch is an active member and chairperson of the Irish Stammering Association promoting awareness and support for people who stammer.  She has stammered since childhood and for most of her life was a covert stutterer but 8 years ago she was prompted to attend speech therapy for the first time because her youngest daughter Bevin also stammers. Through Bevin, she has a special interest in supporting children who stammer and was instrumental in setting up the ISA children’s drama project, ISAYiT! (Irish Stammering Association Youth international Theatre!) She is also involved in providing support for parents of children who stammer.
murphyBevin Murphy is 15 years old and has stuttered since
she was 4. She has been attending speech therapy on and off since then. She has been a member of ISAYiT! (Irish Stammering Association Youth international Theatre!) since it was founded in 2009. She loves going there and meeting all her friends. Bevin has also attended Camp Our Time, USA a number of times and has made lots of friends there too. She says she loved making this video and hopes everyone enjoys it.

This paper and accompanying video promotes the idea that stuttering is like an iceberg; some of it you can see, some of it you can’t see.  Talking about talking can be difficult; drawing an iceberg with a young person who stutters opens up an opportunity for them to express feelings around stuttering.  This can have benefits of feeling more comfortable and more open about stuttering, and this can lessen the impact that stuttering can have.

The teenager’s view – Bevin Murphy

 

I’m Bevin and I am going to talk to you about the iceberg.

Stuttering is like an iceberg you can see and hear some parts of stuttering but a lot more of it is hidden like thoughts and feelings.

There are 2 parts to an iceberg, the smaller part on top and the bigger part under the water.

When you are young it can hard to talk about stammering and what it feels like but you can draw your stuttering iceberg.  You can look back and see how it changes over time. You can pick things you want to work on and change.

Change your attitude, change your stammering.

Thank you for listening.

The speech and language therapist’s view – Jonathon Linklater

Dr. Joseph Sheehan described adult stuttering to be like an iceberg “with the major portion below the surface. What people see and hear is the smaller portion; far greater, and more dangerous and destructive, is that which lies below the surface, experienced as fear, guilt, and anticipation of shame.” (Sheehan, 1970)

As children who stutter grow older, their awareness of their speech difficulties and associated feelings can develop, resulting in their stuttering icebergs growing larger.  Talking about talking can be difficult at the best of times; if a child is stuttering and struggling with speech then discussion of how they feel can be made more difficult.  A visual representation can give a child the opportunity to look at stuttering differently.

Drawing the iceberg

Drawing an iceberg is an easy way to get a child to be more open about their stuttering, and how it affects them.  Clearly the usefulness of this exercise depends on the awareness of the child and should be done with parental or professional discretion.  Children aged 6/7 and upwards who have been stuttering for a couple of years might find this exercise useful.  With these younger children you can draw some faces to represent any stuttering behaviours, or any of the feelings associated with stuttering.  Older children might prefer to use words in their iceberg.

According to Sheehan, the portion of the iceberg above the surface of the water comprises observable, primary stuttering behaviours.  These could be repetitions (“ca-ca-can I go there?”), prolongations (“wwwwwhere is it?”) or blocks and struggle.  Some of the struggle with talking may also be more visible, with facial tension or a child blushing.  Eye contact may also be lost.

Below the surface are some of the more hidden aspects of stuttering.  Secondary aspects of stuttering could include feelings around stuttering such as being embarrassed, feeling nervous, changing words around and avoiding words and situations.

Therapeutic context

In avoidance reduction therapy, clients are encouraged to look at the stuttering more closely, to analyse behaviours and feelings and change them both.  Clients are shown that, with courage, stuttering can be approached, fears can diminish, and the act of speaking handled more comfortably.  Discussion of stuttering, what it is and what it is not can be part of the therapy.  An opportunity to name the feelings and reflect on them with a therapist and others who stutter (and those who don’t) can have therapeutic benefit.

Adults I have worked with in therapy have reflected that if they had the chance to talk about their stuttering feelings at an early age, then possibly they would have grown up with less negativity and stigma around stuttering.

When is a problem not a problem?

Parents sometimes ask if discussing the stuttering could make it worse.  Is it drawing more attention to something that need not be discussed?  I suggest using parental judgement on that.  Questions should not be leading (e.g. “How do you feel about talking?” as opposed to “Do you feel bad about talking?”), of course there can be prompting but try not to use emotive language.  It may be the case that the child may not have a problem with their stuttering, it might be a parent who is more concerned about current perceived difficulties, or what might happen in the future.  As a parent you may learn that there are fewer concerns than initially feared.

Navigation

Children generally do not have as many negative feelings about stuttering as adults; their icebergs may be less complex.  Some feelings may be inconsistent.  Their iceberg may be more like an ice cube on occasions; but that ice cube may still be big for a little person.  Icebergs can change over time; stuttering commonly does not remain the same. Some weeks it happens more, some weeks it happens less and this cycle repeats itself. It can be comforting for young people to know that the variability of their stuttering is normal and to be expected.

Sheehan wrote that “the portion of the iceberg exposed to the sunlight of public view melts away more quickly.” Icebergs may remain, but openness around stuttering can lead to easier navigation through these waters with less fear for all aboard.

The parent’s view – Veronica Lynch

As an adult who stammers my stammering and my attitude to it has changed over the years and keeps on changing, even now.

As a parent of a young person who stammers I have also seen my daughter Bevin’s stammer and her attitude to it change.

One of the things that has helped us both to change is the Iceberg.

Bevin always was, and still is, a sunny happy person and doesn’t tend to let things get her down, and she is determined not to let her stammer hold her back. But like all of us who stammer sometimes she doesn’t feel so good about it. When Bevin was small, maybe about 7 or 8, she got quite upset about stammering and asked me was God punishing her in some way by giving her a stammer. We talked about this for a little while and she was reassured that the reason she stammered wasn’t because she had done something bad.  A wise Speech and Language Therapist suggested I get her to do her stammering iceberg to help her, and me, understand her feelings about her speech.

So I sat down with her one day to do a fun activity, to draw and talk. We started talking about her stammer and her feelings and trying to fill in her iceberg but as she was so young she didn’t always know the words to describe her feelings but I hit upon the idea of using “smiley faces” instead of words. She could draw happy faces, sad faces, angry faces, worried faces, she could draw her face with cheeks red with embarrassment, she could draw other people laughing at her, she could draw herself blocking or repeating sounds. Over the years she and I have done this exercise quite a few times, as she got older and her vocabulary grew she needed to use the smiley faces less.  Sometimes however, there were feelings that couldn’t easily be put into words so our “smiley faces” still came in useful when it was easier to draw a feeling than explain a feeling. I have kept all the icebergs we drew, including my own, and it is interesting to see that feelings do change as we grow and develop as people and change our attitude to our speech.

I think the power of your child drawing their stammering iceberg with you is enormous.

It lets them acknowledge how they feel about stammering and recognise that not all feelings about their speech are bad e.g. Bevin thinks her stammer is cool because it has led her to make friends from around the country and around the world; something she may not have done if she didn’t have stammering in common with them.

It allows you, as a parent, to understand more about how they feel and show them that you understand how they might be feeling is a huge support for them. Even a parent who does not stammer can still say things like “I know what it is like to be worried about teasing, when I got glasses I was worried the kids in school would call me names”. Your child realises that you take their worries and concerns seriously. They are less likely to bottle up their feelings if they know you will listen and accept them.

It also gives you an opportunity to help them challenge some of their negative thoughts and beliefs e.g. if they think they can’t make friends you can talk about the activities they are involved in, the kids who live on their road that they play with or their cousins that they share things with. This is helpful in reducing their negative feeling around stammering and maybe also your own.

Looking at icebergs over time can be useful in helping young people see that even though they still stammer, how they stammer and how they react to it and feel about it can change.

Doing the iceberg with your child is a great way of getting to know your child better and means you can talk about their speech in a fun relaxed way where they may open up to you more than if you asked them directly about their speech.

It is also a great way to explain the complexities of stammering to siblings, grandparents, aunties, uncles, cousins and friends who may not know much about stammering. Your child can enlist your support to help explain their stammer and this helps them feel less isolated.  The more understanding there is around stammering, the less negative impact the stammering can have.

So, I would suggest whether your child is young and only beginning to be able to express their feelings, or if they are a teenager and finding it difficult to share feelings, try spending 10 or 15 minutes doing his or her stammering iceberg, it is a great step to both of you understanding more about your child’s stammer.

References

Sheehan, Joseph G. (1970.) Stuttering: Research and Therapy. Harper and Row. NY

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Comments

Icebergs and ice cubes – the value of discussing stuttering with children and teenagers — 79 Comments

  1. Hello Jonathon, Veronica, and Bevin. I have always been a fan of Sheehan and his Iceberg Theory — thank you for helping us to understand how this can be used with children. I believe that any therapy for children that includes a component focused on eliminating the tip (speech errors) only increases the base of fear and anxiety and struggle. I like your example of challenging their negative thoughts and beliefs too — help them focus on the positive – we all know how a negative experience will pervade our thoughts and emotions. Thank you for your paper and the reminder of what we really need to focus on! Best, Dori Lenz Holte

    • Thank you for your kind comments. I agree negative feelings are all pervasive. As a covert, my biggest fear was people finding out that I stuttered and then I had a startling revelation! If I told people I stuttered then I didn’t have to fear them finding out. It took me too many years to realize this but if children are given the opportunity to bring their fears about stammering into the open they have a much greater chance of minimising the negativity.

  2. Jonathon, Veronica, and Bevin, thank you for this wonderful paper and video. I believe that The Iceberg Theory seems like an excellent way to have children slowly warm up to the idea of stuttering and the feelings that result. I wanted to ask if, at an early age, a child expresses extreme discomfort or is not willing to participate in the exercise, is it best for the clinician/parent to ensure that they get this experience, or should one put the activity on hold until they are a bit older and then revisit? I am interested to hear back from you. Thank you again.

    Sarah Faggart
    Communication Sciences and Disorders graduate student
    Western Carolina University

    • Thank you for you kind comment. Speaking as a parent I found it hard when Bevin got upset with negative feelings about her speech, I felt bad that I couldn’t take away her discomfort. Sometimes it would have been easier not to do the iceberg exercise so I didn’t have to deal with the negative emotions it brought up in me but I also knew it was very important that she be allowed to express her feelings even when they upset her. I was able to support her by telling her that she and I could work together to figure out a way to change some of those feelings. I did the iceberg exercise both when Bevin was upset about her speech and also when she was feeling good about her speech. In this way she could see that her feelings about her speech are not always negative.

  3. Hello!! Thank you for sharing your experiences! I am wondering if in general, most people’s iceberg shows change in a positive way; or conversely, you notice them becoming more upset/angry/sad, etc. over time?

    • Hello Arnesa, my own experience is that feelings changed in intensity depending on the circumstances at the time. Sometimes feelings could be stronger, like anger but then the next time it could have fallen back but could surface again later. I also think the hierarchy of feeling can change, fear was huge for me but has receded quite a bit in importance, feelings of isolation were very high but also fell back. Anger grew for a while when I fully acknowledged the impact of my stammer but that has receded too. The cocktail of feelings & emotions is never static so it is worth revisiting the iceberg exercise every now and then for a reality check

  4. I think the iceberg analogy is a very good way to describe not only the overt behaviors of stuttering but also the emotions behind it. I like that it provides a good visual for explaining and discussing stuttering. I was wondering if a child seems to be handling their emotions should you still try to discuss the emotions or let it be until the child seems ready to talk about it?

    Chelsea Goodman
    Communication Sciences and Disorders Graduate Student

    • Hi Chelsea, thanks for commenting. Good question! I think it’s ok to talk about emotions in stuttering but I wouldn’t make a bit thing of it. If it’s not a problem for them, then we as adults don’t need to make it into a problem. As you say, if they are handling it, then that’s great. As an SLP I have an idea and a plan of where I’m going in therapy, but I let the child lead me too and sometime put out general questions to test the water (back to nautical analogies!).

  5. Thank you for sharing this article! I think this is a very useful activity as it can be used by people of all ages to express their feelings about stuttering in a way that is alternative to speaking. I have a question for Veronica Lynch: Being a person who stutters, how did your personal experiences shape the way in which you communicate with your daughter about stuttering? It sounds like you have done a great job in making your daughter feel comfortable speaking about her disfluencies. Were your parents as hands-on and supportive as you are with your daughter?

    • Thank you for your kind comments. I grew up in rural Ireland in the 60’s & 70’s when the received wisdom about stammering was to ignore it & it would go away. My parents followed that advice and never spoke to me about my stammering & I never attended speech therapy. I became a covert stutterer from a young age and lived that way for many years. When Bevin began stammering one thing I knew for sure was that I didn’t want her to have the secret life I had had, full of fear, shame & embarrassment. I resolved to confront Bevin’s stammering in the open and reduce those negative feelngs as much as possible. This ultimately led me to attend speech therapy for the first time in my forties. So while I have been a support to Bevin, she has been a huge support and inspiration to me in her openness and bravery in dealing with her stutter head on

  6. I’ve heard of the iceberg analogy before and I think it’s a great way to describe many feelings or situations, especially with stuttering. Someone could appear to be comfortable with stuttering but have so many emotions underneath. I also think it’s great that Bevin now thinks her stammering is cool because of all the opportunities she’s had and people she’s met. I think that is a wonderful attitude to have! Not many 15 year olds can say these presented a video and paper for a international conference! Like another commenter had asked: Veronica, how was your stuttering treated as a child? Was it ignored or openly discussed? Did the ice berg activities with your daughter also serve as a therapy technique for you? Would you say that you feel as if you’ve overcome the negativity “underneath” the iceberg or do negative attitudes still exist? Thank you to all three for your contributions!

    • Thank you for your kind words. I hope I answered some of your questions in a previous response. You also asked whether I still have negative feelings about my stammer. I can say that my negative feelings have reduced hugely and when I do have negative feelings I can recognize them for what they are, feelings. Those feelings do not have to define me and I know they can be changed. I don’t think I will ever lose all my negative feelings about stammering, I will always feel a certain amount of regret that I didn’t tackle it earlier, I am sometimes sad at the opportunities I let slip past because of my speech. Doing my stammering iceberg has definitely helped to melt away a lot the negativity.

    • Hi Kelli. It’s Bevin here. Thanks for the compliment, it really means a lot. I really enjoyed doing the video and I am very happy you also enjoyed watching it. I do think my stammer is cool but sometimes I don’t, I do sometimes just wanna slap it round it the head sometimes and just tell it to stop being so hard on me. I am very lucky that I have had the experiences and opportunities I have had and they have helped me become a better person. I have also met wonderful people that I hold dear to my heart. Thanks again.

  7. Thank you for sharing this information. As a graduate student in Speech Pathology I was familiar with the iceberg analogy, but was interested in the ice cube portion. It was so nice to see that this technique was adapted to fit a child friendly environment. What advice could you provide to a beginning SLP on how to be sensitive and receptive to children’s feelings about stuttering? What types of approaches are most effective for young children versus teenagers?
    Thanks again for sharing this information,
    Kia Gronski

    • Hi Kia! It’s Bevin here. I personally found that if you just ask the simple questions such as “How have you found your stammer lately?” or “Do you wish you didn’t stammer?”. Then hopefully you will get a response that leads on to another, more complex question such as “Why do you wish you didn’t stammer” or “How can your stammer become less hard?”. Then again, I’m 15 and I’ve been doing speech therapy for 10 years so this is what I found useful. Thank you for your comment and I hope I could help.

  8. Hi Bevin,

    Your video is very inspiring!. I definitely plan to use the Iceberg in therapy sessions in the future. It is nice to see that at 15 years of age you are not letting stuttering hold you back from doing what you want to do. “Change your attitude, change your stutter” is a great way to look at it. Thank you for being an inspiration!!

    Dulce A.

    • Hey Dulce, It’s Bevin here! Thank you for you comment, its good to hear positive feedback. I sometimes have days where I go “I really can’t deal with my stammer right now” or “Okay, 20 seconds of insane courage!” But at the end of the day, no point in hiding who you are!

  9. Hello Jonathon, Veronica, and Bevin:
    Thank you all very much for presenting this wonderful paper and video on using the iceberg analogy in therapy with older children. Many people find it helpful to visualize their emotions, especially regarding stammering/stuttering. Bevin, I greatly admire your confidence and self-respect! You are a wonderful role model for any girl your age. Like another person posted, not many 15-year-olds get to present a paper in such a prestigious conference. Other than being in this conference, what other positive experiences have you had related to being a person who stammers? Thank you very much! -Colby G.

    • Hey Colby, Its Bevin here. Thank you for those wonderful comments, it means a lot! I have lots of positive experiences, such as meeting up with a group called Our Time. They are a non-profit organisation based in New York City, 8-18 years attend and they learn performing skills, such as acting, singing and dancing. Taro Alexander runs this organisation and he stutters himself. They have also set up a camp, called Camp Our Time and they are based in North Carolina. I have attended this camp many times. I have also been involved in many workshops with other kids who stutter and have made friends through that. I am very appreciative of these experiences and hope that I have many more! 🙂

  10. Bevin, Jonathon and Veronica,
    I really enjoyed your paper (and video). But then I am partial to the iceberg analogy of stuttering. Bevin, thank you for pointing out that when younger it might be easier to draw pictures rather than use words (and Veronica)… thanks for reiterating this in your section of the paper. One of the the things I love about the iceberg analogy, is that it suggests in order to reduce the small part of the iceberg (the stuttering behaviors) we really need to work on the large part under the water. Why? Because the physics of an iceberg is such that it likes to be 80% under the water and 20% above. That means if we blast the top of the iceberg… address the stuttering behaviors, but don’t address the stuff under the water… the iceberg will eventually rise up so that 20% is once again above the water. By blasting away the stuff under the water, the small part above the water (the overt stuttered behaviors) actually decrease as iceberg sinks a bit to keep its equilibrium.

    • Thank you for your comments. As a covert I certainly found that to be true, I have very little obvious signs of stuttering but my under the water iceberg was possibly even more than 80%. Firstly by blasting at that part my top iceberg grew for a while as I became less covert but then I was delighted to find that both the top and bottom began to melt. For me addressing the hidden aspects of stuttering was my starting point

  11. Would you advise using this activity with an adolescent to help create an awareness of thoughts and feelings(as apposed to working with someone who already has an awareness)? I am a speech and language pathology student and I am working with a client who does not have a strong self-awareness, but who is showing clear signs of negative emotions due to his disfluencies. Thank you.

    • Thank you for the question hahansen. If the negative emotions are present then I think you can use this type of exercise to recognise them, and look to make changes. You can use identification work to recognise negative thought processes / speaking anxiety / dwelling on mistakes etc. In recognising them when they arise, your client may be able to handle them better, and handle the stuttering more easily. It may not be a consistently big issue though, so I tend to suggest possibilities (acknowledging that not all people feel the same) and listen to what comes back.

  12. Hi Bevin, Jonathon and Veronica,

    I am a graduate student studying to become a speech-language pathologist and am currently taking a class that focuses on stutter. I really enjoy learning about stuttering and hope to work with individuals who stutter in my future career.

    I just wanted to express that I thought your paper was wonderful and the video was truly touching. It is amazing how a short video clip can emphasize how an individual who stutters could be feeling at any moment of the day. We have learned about the iceberg illustration in class and how therapy really should focus on the whole iceberg not just what is heard or seen. I think that your paper really demonstrated how important it is for individuals to be able to explore their feelings no matter what age. I think that using faces for younger children is a great idea and definitely something I will keep in mind for the future. This paper has made me realize how important it is to use the iceberg illustration continuous throughout therapy so that the person can see how they have grown when looking back on their previous illustration. I have a question for who ever can answer. I know your paper discussed that a parent could use the iceberg illustration with their child. I was wondering should the parent be present in therapy when the activity is conducted the first few times so that the SLP can provide support or guidance when needed, before having the parent conduct the activity at home? What has been your experience in this situation?

    Thanks again,
    Joanne

    • Thank you for your question Joanne. In my case I had done my iceberg so i knew how to do it so the first time I did it with Bevin it was just the two of us. As a parent I think it would be useful for the therapist, parent & child to work on the first iceberg together, I think this has the benefit of explaining the exercise, explaining the benefits of the exercise and also ensuring that the exercise is child led i.e. it is the child who fills it in rather than the parent.

  13. What a great way to enlighten children (and adults) about their own perceptions of their stuttering! I can see how this idea of drawing out one’s own stuttering Iceberg to get a handle on one’s own feelings/doubts/fears/etc. can be beneficial to a person that stutters. Would this be an effective way to advocate for stuttering among individuals who do not stutter? Perhaps a presentation for a school, or having a person who stutters’ family draw out their own icebergs for feelings they have regarding a different subject (perhaps something they had/have difficulty with). Please let me know your thoughts.
    Thank You,
    Daniel Carnley
    Idaho State University Graduate Student

    • Thank you for your comment. I think it is a good way to start up a conversation about stuttering and explain that it is not just the visible aspects that people struggle with but the hidden ones as well. Sometimes people who don’t stutter can minimize the impact of stuttering by saying ‘oh, it’s no big deal’ but explaining the iceberg analogy can show how sometimes it is a big deal for the person who stutters

  14. Hello Jonathon, Veronica, Bevin,

    My name is Maureen and I am currently a graduate student studying to become a speech language pathologist. I am currently taking a fluency class that is focused on stuttering and I participate in an externship program at a behavioral and emotionally disturbed school.

    Thank you so much for sharing your personal experiences with us and especially making such a heart warming video. Mentioning to draw pictures instead of writing words is such a great way for children to express their points of view. Your paper definitely encouraged me to try the iceberg activity at my externship program with a student who stutters to help him express his feelings and emotions toward stuttering. Bevin, I love how you mentioned that you think stuttering is “cool” because it led you to making friends across the world! What a fantastic experience and positive attitude you have. Since many individuals do feel anxious, sad, or fearful of stuttering have any of you ever experienced a situation when the iceberg activity did not work? Maybe because the individual was so down about themselves, or frustrated with their stutter?

    Thanks so much,
    Maureen Duggan

    • Hi Maureen.

      Good Question! I think sometimes people aren’t always in the right place to do the iceberg exercise (or whatever therapy you have planned) so you do need a plan B. Sometimes those are the best sessions and it gives the client what they really need that day, rather than what we as SLPs think they need!

      You may find that there’s really not that much making up the iceberg, and it is an ice cube which isn’t causing (m)any problems. Which is a good thing!

      Jonathon

  15. Hi Bevin, Jonathon, & Veronica,
    I just recently learned about Sheehan’s Iceberg Analogy in my fluency class. I think this is a great application for using it with children and young people. It would be an excellent way to discuss a client’s feelings regarding their stutter and provide more information about the covert aspects that they may not readily share. I also really like the idea of continuing to draw it over months or years so they can see how their feelings change over time. Thanks for sharing.
    Christy
    Graduate Student

  16. Hi Jonathon, Veronica, and Bevin. I enjoyed hearing about your personal experiences with stuttering, along with the activities you found beneficial. My name is Marissa and I am currently a graduate student studying speech-language pathology. As a future speech-language pathologist, I’m intrigued to hear different approaches used to discuss stuttering. I learned about the iceberg theory in my Fluency class recently and thought it was beneficial for explaining the covert and overt characteristics of stuttering. The iceberg breaks down the overt characteristics (such as the stutter itself, or secondary behaviors) as the small tip of the iceberg, and the covert characteristics (feelings associated with stuttering) as the more significant part of stuttering that people can’t see. I believe this activity is so constructive for children and adults because it provides them with a visual to understand what they are going through. I also thought it was a great idea to do the iceberg activity continuously to see the variability in stuttering, along with how one’s thoughts/aspects changed over time. Bevin, I really enjoyed your video clip. I think your story could really help other children/young adults who stutter because you have such a positive outlook! Teaching others to “change their attitude to change their stammer” is essential for learning acceptance. Do your friends share the same philosophy?

    Thank you!

    Marissa

    • Hey Marissa, Bevin here. Thank you for those great words, I really like to hear that people have enjoyed my video! 🙂 My friends are all different so they all think differently too! I think some of my friends believe that if you have a different attitude towards something its better then having moany attitude, you get more done or in this case you can have a different approach to things, such as your stutter. But some of my friends are still learning that. Thanks again 🙂

  17. Hi Jonathon, Veronica, and Bevin,

    I enjoyed reading your article regarding the stuttering/stammering iceberg. I also appreciated the video containing Bevin’s personal stammering story. It really served to demonstrate the more “covert”, or hidden, features that I have learned typically occur concomitantly with stammering. I am currently a second-year graduate student studying to be a speech-language pathologist. We have recently learned about the importance and clinical significance of the iceberg activity in my Fluency Disorders course.

    Jonathon shared some of the perspectives held by Dr. Joseph Sheehan, the creator of this iceberg, and I found such information to be insightful. You provided reasoning behind this strategy being used clinically and explained the positivity about one’s stuttering that can arise simply from viewing a visual representation of his/her personal stuttering experiences via use of the iceberg diagram. I like that the iceberg can encourage openness and overall increased acceptance about an individual’s stammering behaviors and feelings. I will certainly take these recommendations for treatment into consideration when I am treating my own clients who present with similar backgrounds. I loved the analogy you all shared about the ice cube as opposed to the larger and more complex iceberg, as well.

    You also mentioned that it is considered normal for a person’s stammering tendencies to change over time, which we learned about in class and referred to as “developmental stuttering”. I believe the term was created to represent the changes we are likely to see in people’s stuttering throughout the lifetime.

    With respect to the iceberg drawing activity, information discussed in your article made me wonder about something. I am curious if a parent drawing the iceberg representation with his or her child would be more, less, or similarly beneficial than/to an SLP participating in this creative activity with the same client. Might bias be a factor when it comes to family members creating these diagrams? In other words, do you think it would be more likely for parents to move toward asking closed-end questions to hear the kinds of things they want to hear their children say? How might this drawing experience be different between a parent and child who both stammer, versus a child completing it with a parent whom does not stammer?

    Conversely, would an SLP leading this activity have too meaningless a relationship with a client to perform it accurately? What are your opinions on this issue? I am particularly interested in hearing your thoughts, Veronica, as a parent who stammers of a young woman (with great stage presence!) who also stammers. Thank you for sharing, and I look forward to hearing your thoughts.

    Best,
    Cara

    • Thank you for your kind comments.
      As a parent I think that the important thing about doing the iceberg exercise is that the child should give the main imput and the parent should not so much direct the child but encourage the child. So, you are right, closed questions are not helpful so I would say parents should try to use open questions and encouraging statements e.g. ‘how do you feel when you stutter in front of your teacher?’ and then following up their answer with another question like’ anything else?’ and then maybe a statement like ‘ it isn’t nice to feel like that sometimes’. This kind of questions & statements allow children to express feelings but also for the parent to show that they understand the impact of the emotions their child might be feeling

      It is a bit easier if both parent and child stutter and have completed their iceberg but I think parent’s who don’t stutter can still share their own experiences during the exercise. They can draw experiences from their own childhood maybe about wearing glasses, being taller or smaller than their friends, not being good at sports, being geeky or whatever their own particular thing was. They can use those experiences to empathise with their child.

      I don’t thing their is a right or wrong way to do the exercise and obviously the first time doing it can take a while to get the hang of but I do think it is a worthwhile exercise for both parent and child

  18. Jonathon, Veronica, and Bevin,
    Thank you so much for sharing this story! You all have truly hi-lighted that a positive outlook goes a long way in intervention.Veronica said it best, “change your attitude,change your stammering”! It was also great that she pointed out that by writing out your feelings about stuttering, you can choose which qualities you want to work on and change. It is also a great way to measure how a person’s attitude has progressed over time in therapy. What advice would you give to SLPs or parents when the child is not as willing to share how their feelings with you? Thank you again!
    -Jessica Gatas

    • Hi Jessica. Thanks for the question. My experience as an SLP suggests that we don’t push anyone if they aren’t keen to share feelings. I also stutter and I’m careful not to project what I may have thought as a person who stutters on to others – my experience may have been very different. I think the same applies here, if it’s not an issue for them, then we don’t need to make it an issue, people often talk about things when they are ready and the time is right. It’s good for parents and SLPs to talk to each other and keep a watchful eye over the situation – and be ready to listen.

  19. Hi Jonathon, Veronica and Bevin,

    Thank you for your enlightening paper and video! As a graduate student of speech language pathology, currently enrolled in a fluency course, I have heard references to the iceberg analogy, but it never occurred to me that it can be implemented into therapy as a creative and valuable tool.

    For whoever can answer: If you find that a PWS is experiencing many negative emotions when drawing their iceberg, how much of the session is then focused on addressing those negative feelings and how much is focused on techniques for targeting the stuttering itself? Also, would you advise using the iceberg representation as a group activity where PWS can discuss their experiences in a supportive environment or is it better addressed in 1:1 sessions with more focused attention on the individual?

    On a classroom level, if a teacher has a student who stutters in her classroom, what are your thoughts on her openly discussing and demonstrating the iceberg analogy and stuttering with the entire class? Do you think this may force a CWS to receive unwanted attention or do you think a CWS will benefit from the open discussion?

    Thank you again and all the best!
    Leah

    • Hi Leah… great ideas in your comment.

      Re. address feelings / technique work: I usually try to do a bit of both. People often want to take something practical away from the sessions, but it’s important for them to know that working on changing attitudes and feelings is just as important too.

      Group icebergs can work really well. Everyone can do their own iceberg afterwards, as people are bound to be a bit different from each other. It’s important to facilitate the discussion so that everyone gets a chance to speak, especially as some may find talking in a group more difficult than others.

      Re class discussions: I’ve done that a few times as an SLP and it’s always after discussing implications with the youngster, the parents and the teacher. I’d make sure everyone understands the process and is willing to take part. Kids I’ve worked with have enjoyed the sessions like this; we watched a video and did a quiz about stuttering too. Some kids haven’t wanted to do it though, that’s OK too!

  20. Thank you so much for sharing your experiences with stammering! I love the use of the iceberg activity and that as a mother, you completed the activity together. As a future SLP, I think this activity could be beneficial with the parent and also the clinician. Brevin is already such a strong person at 15, I can’t wait to see all that she will accomplish in the future. Also, thank you for creating such a lovely video; I will be saving that as a resource for future clients! I might as well add that I loved listening to Brevin speak and she has a beautiful voice. Changing your attitude about stammering has a big impact on changing other peoples’ attitudes about it, so thank you again for teaching such a great lesson!

    -Courtney Bull
    Second Year Graduate Student
    Idaho State University

    • Hey Courtney, its Bevin here. Thank you for those kind words, its much appreciated! Its a real boost when I see that my experiences can help others and that I have strong encouragement from others to keep going and to never give up! I would love to maybe become a SLP or a writer when I’m older, so I hope this will maybe help me! Thanks again. 🙂

  21. Hello Jonathon, Veronica, & Bevin-
    I am in my final year of the graduate program, studying to become a speech-language pathologist. This semester I am enrolled in a Fluency Disorders class and have learned a lot about the “Stuttering Iceberg,” which specifically drew my attention to your article and video. I strongly agree that using the iceberg analogy would help individuals who stutter and is extremely beneficial for all parties involved. I would absolutely use this strategy with future clients I may have one day. In my Fluency Disorders class, the emphasis has mostly been on adults who stutter, so I enjoyed seeing and hearing how it had helped Bevin and how it can work with children in order to express themselves; especially, because “talking about talking can be difficult.” The iceberg gives the individual the chance to express what is going on “inside” and that is such a huge aspect of stuttering. I liked the idea that as the individual grows and changes, his or her feelings may also change and develop further, and so the “underwater” portion of the iceberg can then change to properly depict the covert features occurring and then the emotions drawn on the iceberg can be discussed with the clinician. The iceberg analogy is so insightful for all; whether it be individuals who stutter, family members, those in the field, or those who simply want information about stuttering, because it truly puts the topic of stuttering into perspective for an easy and visually representative way of understanding it. “Change your attitude, change your stammering.” This is such an inspiring way of talking about and expressing what is felt with stuttering.
    Thank you for sharing this information!
    -Alexa Spinelli

  22. Thank you for giving three distinctive points of view about drawing an iceberg and stuttering. I am a graduate student taking a class of fluency and the iceberg activity has been brought up. However, I did not get an explanation of the activity from the parent or PWS’s point of view. It helps everyone understand and shows stuttering’s true complexity. How do you pick aspects to work on if the PWS draws or writes a lot of things on their iceberg? Do you include the PWS in the decision?

    Thanks!
    -Brianna

    • Hi Brianna, thanks for the comment and questions. I think you can pick different things to work on at different times, that’s where it’s really important to see what the person wants to work on. Sometimes what we might think is important from an SLP perspective isn’t the biggest worry for the person. You may have limited clinical time depending on where you work, but you can still get the person to set targets and work gradually on making changes. It’s good to let the person know that change can take time, and there will be ups and downs.

  23. To further my above post:
    If the iceberg analogy is not something the client is interested in doing, how would you go about presenting this strategy in order to try to gain some interest? I know that some children, or even adults, may not be open to expressing themselves through such an activity, yet the results can be so beneficial and it would truly be in their best interest to participate in using this strategy during therapy. Therefore, I was wondering if anyone had suggestions for how to best present this strategy in order to get the most out of it.
    Thanks again!
    Alexa Spinelli

  24. I have seen the iceberg diagram before as an illustration of some of the various emotions individuals may experience, but not as part of therapy. I found it enlightening that it was used to assess the point of view of persons who stutter as well as what emotions that they may anticipate from others. I can see how this can help individuals understand their feelings and empower them in various ways especially by expressing these feelings to other. Additionally, how important it may be to complete this several times as different emotions and behaviors may arise and evolve. In doing so, those who interact with persons who stutter may respond to these individuals more appropriately. Recently, we had a panel of persons who stutter come into our class to speak with us. I recall how one panelist expressed how he felt his father was not supportive of his stutter due to his responses. Although some of the responses may seem supportive at the time, I realized how they are inappropriate and aggravating they can be. For example, “it’s okay, take your time”, “you can think about what you want to say”, etc instead of patiently waiting for the person to finish. After the panel, I felt I have a different understand and perspective of stuttering.

    • I agree that doing the iceberg at different points in time can be helpful to look how emotions have changed, have some disappeared altogether and been replaced by something else or have some emotions decreased. I think you are also right about over time some emotions that may have been too painful to articulate at first can become a bit easier to include in your iceberg.

  25. Hello Jonathon, Veronica and Bevin,
    What a great contribution to this years ISAD conference. Thank you for sharing from all 3 perspectives.
    Veronica – it’s good to see you here sharing your story. As you may recall from our podcast, I can certainly relate to being covert. I’m glad we’ve both stepped away from that.
    I’m delighted to “meet” your daughter and to learn how much you two talk about stammering together.
    Bevin – what a great video. Thanks for sharing and being so courageous. Not everyone can push out of their comfort zone the way you have. Bevin, do you ever have any trouble with teasing by kids in school? How do you manage it?
    What advice could you offer for talking to 10,11 and 12 year olds about teasing? I’m doing a presentation to a middle school on stuttering and compassion and I want to bring up teasing in the best way possible to this age group.

    Thank you all for such an inspiring piece.
    -Pam

    • Hey, Pam! Thank you for that wonderful comment! I’m lucky to have my mother and Johnathon to help me become more open and confident! I fortunately do not have any problems with kids teasing me or bullying me! But if I did I would either tell them to stop being so stupid or ask them why they are so mean? Then I would tell my parents and a trusted teacher! But if you tell them that teasing or bullying is NOT okay and that they shouldn’t put up with it, then I think that would be good! Thanks again and good luck with your presentation!

      • Hello Pam, thank you for your comments. Yes, being covert was not a happy place to be and I have moved away to a large extent from that road. There are still time when I find it hard not fall back into my old ways for example, when I am with people who knew me as fluent and not as a PWS I end up playing the role of a fluent person. But then Rome wasn’t built in a day and now when I do fall back into old habits I can acknowledge and move on without the hideous self criticism, that is a huge step.
        I am glad you got to meet Bevin, as I mentioned in the podcast she is my inspiration, she is why I had the strength to look at and accept myself as a PWS

  26. I believe that The Iceberg Theory seems like an excellent way to have children slowly warm up to the idea of stuttering and the feelings that result. I like that it provides a good visual for explaining and discussing stuttering. I also feel this would be a great resource to show the parents, relatives, and others that may not fully understand why people stutter and that it is much more than just the surface behaviors.

    As a graduate student in Speech Pathology I was familiar with the iceberg analogy, but was interested in the ice cube portion. It was so nice to see that this technique was adapted to fit a child friendly environment. I was just wondering if you have found other examples of way to help children cope with stuttering? Has this been more successful with the child, parents, or both?

    Thanks again for sharing!

    JennaE

    UWSP Graduate Student

  27. Thank you for sharing the iceberg analogy! I think it’s a great outlet for children to express their feelings and concerns about stuttering and face what’s below the surface. I had never considered using the analogy as a means to explain stuttering to others, or the idea of continuously drawing different icebergs over time to see how they change. I think both of these practices add even more meaning to the concept and act as an ongoing therapeutic process. I’m curious if you’ve found any differences in the types of responses or drawings between girls and boys? In other words, do young girls and boys describe their stuttering experiences differently? Since the icebergs can change with age, it made me wonder if they changed by gender… Either way, thank you for sharing your experiences!

    Bethany Bauer
    SLP Graduate Student
    University of Wisconsin

    • Hi Bethany, great question!

      I think the characteristics are pretty similar but I’ve not looked at gender differences in icebergs. That sounds like a research project for you 🙂

      At our National Stammering Awareness Day (in Ireland) this weekend Triona Lanigan presented on her Doctoral research. There were some gender differences suggested in her study about how adults felt about stuttering but it was a small sample. The presentation will be up on http://www.nsad.ie soon.

  28. I think the iceberg analogy is a great way to involve children in thinking about their stuttering. It allows children to express both their positive and negative feelings about their stutter. I also think it is a great way to show children how their feelings about their stutter can change over time, as they become more comfortable and learn to cope with their stuttering. I think this would be a very useful tactic in therapy sessions with children who stutter. Have you found a good age to begin using this with children? I really liked Veronica’s idea of using smiley faces to describe feelings. I feel that this would be a good way to get younger children to describe their feelings. I wondered if this would make conceptualizing the stutter much easier and help the children to put a visual with how they are feeling about their stuttering at that time. Have you found this to be true? I also had the question of do you think it would be more successful to have the child complete the iceberg in the presence of his/her family, especially with family members who also stutter? Veronica, from your testimony, I felt it really helped you and your daughter to connect more and it helped you to understand exactly how she was feeling about her stuttering. I thought it was amazing that you guys could relate to one another on that level. Do you think this would be helpful for parents who have never dealt with stuttering before? Thank you so much for sharing your personal experience! It was great to read and see how much the iceberg analogy helped both yourself and your daughter!

    Brittni McPherson
    SLP Graduate Student
    Appalachian State

    • I am interested to see the response to this post as well. I would imagine that it would be greatly beneficial (in most cases) to include the family in the iceberg activity. I could, however, see where it might be added pressure or stress for the child to do so with the parent or family present early on. Depending on the family situation or parental involvement, it may be uncomfortable at first for the child to involve their family. I love that the iceberg activity can be repeated over time and show the progression of one’s perspective on stuttering. Once a child has developed a strong foundation on their feelings about their stutter, maybe then it would be more comfortable for them to invite their parent(s) to become involved.

    • Hi Brittni,
      I am glad you liked our approach. Yes, I do think that the iceberg would be useful for parents who have no experience of stammering. It works to allow the child to express their feelings and to educate the parent. I have found that quite often parents struggle to grasp the emotional aspects of stammering and can be quite surprised to see the amount feelings their child has around stuttering.

      My own feeling is that it is best for the child and SLP or child & parent to complete the iceberg as this can make for a special time and the child may be more likely to express feelings. I do think that the completed iceberg can be used to explain to family members the impact of stammering visually without the child having to go into long explanations

  29. Thank you for sharing the iceberg analogy! As a SLP graduate student I was familiar with this analogy, but love how you have applied it to help children understand their feelings. It is important to involve them. I often wonder how the child feels when they realize they are not like everyone else around them. This is a great activity to do with children and I enjoyed how you altered it to a child’s level when they don’t have the vocabulary to express their feelings. This activity really gets them talking about their stutter and how it makes them feel.

  30. Dear Jonathon Linklater, Veronica Lynch and Bevin Murphy,

    Thank you so much for presenting this piece. As a graduate student going for speech-language pathology, I always wondered how to help PWS in expressing their emotions appropriately. Many people outside of our field are unaware of the emotional struggles that these individuals go through. Similar to Tourette’s Syndrome (which is important to me because my brother has it), it is not just the stuttering sounds and secondary behaviors you see. There is so much more encompassed within stuttering, such as anxiety and poor self image that these individuals have.

    I hope to use this technique of the “ice-burg” to help those who stutter have a better understanding of their own emotions. This technique can also be used to provide insight to those who do not stutter, and help them have a better understanding of the emotional impact it has on those who do. Something as simple as even drawing this image on the blackboard in a school can show children that their stuttering peers get upset and embarrassed when others make fun of their disfluent speech output. This strategy can make a huge difference, and I will be sure to implement it in my future.

    One question for the authors:
    Do you think that it is important for PWS to get therapy from a psychologist? I know for my own personal experiences of my brother having Tourette’s that having these involuntary sound productions has such an impact on self confidence and anxiety. Do you recommend your patients/clients to seek therapy as a tool for mental health and staying positive when times are tough?

    Thank you so much!
    Allison Cullinan

    • Great observations, Allison. Neither Bevin or I get therapy from a psychologist, however, I think it is important to do work in that area. I know Bevin has worked with her speech & language therapist on problem solving, looking at the supports, skills and strengths she has in her armoury of tools. I also see it as important for me to work on the hidden aspects and looking at the positive aspects of my speech, I would have done this through speech therapy groups and peer group support

  31. Thank you for sharing. I found it very interesting and informative to have the dynamic of all 3 of your perspectives tied into one paper. I am a graduate student and also happen to be working with PWS in one of my clinical placements. I think this activity is one that our clients could greatly benefit from.

    I am wondering if this is a technique that is found to work best in the home (or more personal setting) of a PWS, or if it is also implemented in therapy sessions. If it is implemented in clinical/therapy sessions, how often do you recommend doing it? Do you find that it is something that you simply do and then move forward with other activities, or is it best to discuss it right away?

    Again, thank you!

    Sarah Savarese
    CSD Graduate Student

    • Good comments Sarah, I think it’s fine to do in whatever setting feels right. As for how often, you could do it at the start and end of therapy blocks, or once a year – again it’s how often it feels useful to the client and enables them to see changes. I would tend do discuss it there and then, and if refer back to it when necessary.

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  33. What a great read. I loved that you all incorporated the three very important perspectives in this article. I am a huge fan of the iceberg activity. Jonathon, I appreciate your input on time frames and age ranges of when you think it may be appropriate to being this activity. Veronica, your willingness and desire to connect with your daughter on a deeper level in regards to stuttering is an inspiration. I believe it can be hard for parents to have those uncomfortable talks with their children, and you are a great example of a parent who is willing to face it head on a deal with it. Bevin, what an inspiration you are! The world needs more people with positive attitudes like yourself! For a brave girl like you who owns and is confident with your stutter, how did you or have you handled situations where you may have been teased or bullied because of your stutter, if that has happened?

    Thank you!

    Ansley McSwain
    SLP Graduate Student Appalachian State University

    • Hey Ansley, Bevin here! 🙂 Thanks for your comments 🙂 I fortunately didn’t experience any teasing or bullying for my stutter,when I was younger. I although have heard a lot of stories (I won’t mention names) about terrible things, such as walking up to a parent and telling them they had a stupid ugly child or a teacher making fun of their students stutter! These kids have then told their teachers or parents about it. I was completely shocked by these incidents and I would never want anything like that to happen to me. Now that I’m older I still haven’t had any incidents and I am very lucky. So in response to your question, I believe that if you tell someone you trust and you can work something out together. Thanks again, I hoped this helped. 🙂

  34. Bevin,
    Also- in regards to my question above, how have your responses to any teasing changed over the years as you have become more confident in yourself and your stutter?

    Thanks!

  35. Thank you all for sharing this story. I had heard about the “iceberg” analogy before, but really enjoyed how you utilized this analogy to help drive therapeutic intervention. I really appreciate how this strategy gives the child/adult a chance to explain what is going on and gives them a chance to advocate for them self and begin to learn this skill. Do you find that by empowering them early on to discuss these feelings, they are more confident in their adulthood? Also, do you find that by sharing how they are feeling, people who stutter feel more comfortable speaking and do you see a reduction covert aspects of stuttering?

    Thank you!

    • Yes, I think that talking early about stuttering is healthy when they have some awareness. It lets kids know that they can do something about their stuttering and it need not hold them back as they grow up. I think it can lead to a reduction of more covert aspects, but I that also depends on experience, personality and other variables i.e. everyone has ups and downs. Sometimes you might also find there’s a bit more stuttering taking place, but I think that’s OK especially if the kid is talking more and saying what they want to say!

  36. Dear Jonathan, Veronica, and Bevin,

    Thank you for your informative video and paper! I am a second year Speech-Language Pathology student. I really liked how the iceberg activity was both creative and visual. I work with some very visual students and I was wondering, are there any other creative or visual activities you found useful in therapy? Also, what strategies did you find helpful when you became frustrated or upset?

    Thanks again!
    Eileen
    Idaho State University Grad Student

    • Speaking as a parent I think the iceberg was helpful in bringing up the negative feelings that may have otherwise stayed hidden. I would have empathised with Bevin if she got upset and talked about what might help her find ways to reduce those negative feelings. Sometimes it is important to let the feelings sit for a while and then revisit to do some problem solving around the feelings or talk about if the feelings are realistic e.g not everyone thinks you are stupid if you stutter, your mom & dad don’t, your sister/ brother doesn’t, your sports coach always picks you, your dance teacher gave you a lead role. In this way helping the child to see the feelings for what they are, feelings but necessarity the truth

    • Hi Eileen, thanks for the comment and questions. I’ve been on stuttering therapy courses where art therapy was used and clients reported that very useful. We had an art therapist involved which supported our team. Getting kids to draw a picture about stuttering or to make a poster for International Stuttering Awareness Day can be fun.

  37. Hello Jonathan,

    After reading your paper and watching your video, I feel more confident in helping people who stutter accept and discover themselves. I also enjoyed your activity as it not only provides an interactive model but it makes therapy client centered as it should be. Thanks for sharing.

    Sincerely,
    Omar

  38. I am also a student studying to become a speech-language pathologist. I am currently enrolled in a class about stuttering and I recently learned about the iceberg activity. This article caught my attention because I have learned that stuttering can be very different for many people. The person who stutters can describe his or her own personal journey through pictures or words. Thank you for sharing your story!

  39. Hello!

    I absolutely love the idea of drawing your own icebergs. I also really like the smiley face idea for younger kids, or for someone who just can’t find the right word 🙂 I am passing this on to my friend who has a child who stutters on her caseload. Thank you for sharing your experiences!

    Gina
    SLP Graduate Student
    Idaho State University

    • I am delighted that our experiences can help others. One of the things I like about the iceberg is that it can be used with younger kids and with older ones too.

  40. Hello,

    What a great tool in getting to understand and validating a PWS. What strategies could be used for those who are reluctant to share about their feelings or inner-state in regards to one’s own stuttering? Have you ever experienced any PWS who displayed such reluctance?

    Thank you,
    Maggie (Graduate Student)

    • Hi Maggie, thanks for the question. Yes, sometimes people aren’t always keen to talk about it. I think a careful approach is needed, and being ready to listen. If you don’t have access to group therapy, sometimes getting a client to watch a video of other people who stutter can make them more open to share ideas – clients can often relate to other people who they’ve seen / head on video and you can draw questions from that.

  41. Thank you so much for this amazing idea. This would be a wonderful tool to use in therapy or have the the parents use at home to help communicate with their children. It can be difficult for children to express how they are feeling and this is a great outlet. How often would you recommend we complete this activity with our clients?

  42. Thank you to everyone who has read our paper and watched our video. It’s been great to read your comments and answer questions.

    Thanks also to my co-authors Veronica and Bevin without whom there would be no paper!

    I’m pleased that people feel they can take the exercise away, talk more about stuttering and melt some icebergs!

    Happy ISAD! 🙂

    Jonathon

  43. Hello,
    I recently did a project on the approach-avoidance conflict theory of stuttering and came across the iceberg image. I understood the concept but not necessarily how to implement it when working with people who stutter. Thank you for elaborating on how to present it to clients of different ages. I also loved the parent perspective. I never saw the iceberg as a tool that could be used to increase parent-child understanding.
    Thank you,
    Breanna