About the Author:
Michael Susca, Ph.D., C.C.C.-SLP, BCS-F, is an associate professor at the University of the Pacific. Dr. Susca is an ASHA Board Certified Specialist in Fluency, a member of the Special Interest Group Four—Fluency and Fluency Disorders, and has over 40 years experience in treating people who stutter. Dr. Susca has published in national and international journals, presented at state, national, and international conventions, and is a former person who stutters himself. He also continues a small private practice primarily for people who stutter.
Which word caught your eye: “curing” or “stuttering”…..or both? My bet is that you had a stronger response to the first word than the second word. Ask yourself what motivated your response.
In the stuttering community, “cure” is a loaded word. Sometimes it is used as a noun, other times as a verb (and sometimes as a pejorative.) If you look up its definition in a dictionary you will find multiple definitions. One’s perspectives, experiences, knowledge, and contextual use of the word will also influence its meaning to an individual. As an academic, researcher, SLP private practitioner, BCS-F, person who stuttered, and an old man nearing 70, I wish to share some thoughts about this word that sometimes needlessly divides the stuttering community. I hope to broaden our conception of functional communication for PWS and decrease myopic, singularly narrow definitions, approaches, and solutions to the clinical experiences of stuttering and its intervention. I’m sure to incense some readers, but that is not my intention. I simply hope to expand our understanding of communication with or without stuttering.
Is stuttering curable? Yes. Is there A cure for stuttering? No. Is the goal of stuttering therapy to eliminate stuttering? I don’t know, ask the client. Must stuttering be managed or can it come and go unexpectedly? In some cases yes and in other cases no, to both questions. Substitute the word “cancer” for “stuttering” in these questions and I’d come up with the same answers. Parallel to cancer, to understand stuttering as a finite, unidimensional, simple event is to miss what stuttering is.
Most of us recognized the multifactorial, complex, and dynamic characteristics of stuttering. Because of that, it is silly to think of stuttering as a singular, concrete (i.e. observable characteristics), and static “thing” to address, which the term seems to imply for many. For some, that later viewpoint may apply if the PWS is seen at a good point for personal change and is able to eliminate stuttering to a point where it is no longer an issue in communication. That might be the “cure” many mistakenly apply to the results of therapy to some stuttering. For others, a reduction in the periodicity, duration, severity, reactions, struggle, agency, and/or difficulty with social communicative functioning may be sufficient. Let me use myself as an example.
I started stuttering at age 4. It was the beginning of a life process of change: my path. In retrospect (and after lots of education and counseling) I have identified multiple factors that I believe contributed to my stuttering. It is important to note there may be a whole set of different factors contributing to someone else’s stuttering…..but back to me. My parents set me up with one SLP and I went from “bad” to “worst” in that I often ended up writhing on the floor trying to get a sound or sequence of sounds out through my bodily contortions when responding to comments or volitionally making my own. Of course, being quiet and not speaking at all was a more comfortable response (for me and my listener.) My parents eventually set me up with a new SLP who guided me to greater fluency (but not elimination of stuttering). I got to a point where I was comfortable and accepting of myself as a mild to moderate PWS….at least I could remain standing while I stuttered my utterances. In contrast to the severity I formerly experienced, I could remain at this level of disrupted spoken communication and be happy for the rest of my life. The relative level of distress and discomfort speaking was much reduced. But like so many PWS, I regressed (or relapsed), started returning to my physical secondaries (and withdrawing in school participation on many fronts) and returned to my second SLP. After a few more years of speech therapy, and encouragement from my SLP, I entered the field of Speech and Hearing Sciences, with a special interest in treating people who stuttered. I have worked with many people who stuttered throughout my life, each of whom had different outcome(s) specific to him or her. Although all had the problem of stuttering, no two followed the same path (even siblings.) Many had changing paths during the duration I knew them. Many (including me) underwent a protean process of change. Today, I no longer stutter. Some would call that “cured”. But during my period of mild or moderate stuttering, I felt “cured” because I was a functional communicator who happened to also stutter. I was an impaired communicator when I relapsed and spent a lot of time managing my observable speech, exploring my thoughts about myself as a communicator, and my dealing with feelings that varied with various situations one finds oneself communicating with a stutter. I was naturally fluent after my Master’s degree and upon entering my first year as an SLP. It was not for another 25 years that I could comfortably refer to myself as a “former PWS” or “cured” (in the sense of no longer having an observable stutter and all the “below the surface” components that accompany it.)
Note that my path, and the path of many people I have treated, is along a path focused on being a functional communicator, NOT experiencing communication as a PWS or not. When we focus on stuttering vs. not stuttering or cured vs. not cured, we are missing the point of a PERSON and being a person with functional communication. Functional communication implies degrees of self-expression with perhaps different levels or forms of stuttering or fluency. The “cure” of stuttering may be the idea of communicating a thought, feeling, experience, or desire from one individual to another, as efficiently and effectively as possible, however that is defined for that individual. For some, curing stuttering may be entering uncomfortable situations and verbally expressing oneself regardless of the level of stuttering or fluency. For others, it may be having the confidence to express an idea to influence decision making in a group. Maybe it is making a joke or quip in a social context. Consistently saying what one intends to say, speaking with less struggle (not necessarily the absence of struggle), and/or have a sense of full being, intactness, and total communicative self-reliance are all markers of “curing stuttering.” Thus, curing stuttering becomes an individualized definition and process.
Back to the cancer metaphor. There is no one type of cancer, as there is no one type of stuttering. Cancer comes in many forms, as does stuttering. Cancer comes in many degrees, as does stuttering. There are many forms of treatment for cancer as there are different kinds of treatment for stuttering. There are different choices of treatment for cancer patients to choose from, as there are different choices of treatment for stuttering—in each case a choice of the patient to the options presented by a professional. Is cancer curable? Yes. Is there A cure for cancer? No. Some people can be “cured” of their cancer, but not all cancer is curable. The same is true with stuttering (in terms of absence or experience of the problem.) Some people learn to live with their cancer, so it is with stuttering. Sometimes there are multiple approaches to manage cancer, so it is with stuttering. As there are different cancer support groups, there are different stuttering support groups. In all cases (of cancer and stuttering) the challenge is to find the best solution or combination of solutions to allow the individual with the problem to live out his or her life to the fullest. There is no one solution to whatever problem(s) with which one is living.
So let’s stop focusing on singularly curing stuttering, modifying stuttering, enhancing fluency, developing positive attitudes of self and/or stuttering, using cognitive behavioral therapy, counseling, developing mindfulness in stuttering therapy, or engaging in A tool in the treatment of stuttering. Let’s focus on enhancing the person’s effective and efficient communicative functioning, however defined, as individually determined. Let the client’s changing needs guide us to draw from multiple strategies so they may live their functional communicative life to its fullest.
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