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What causes stuttering?

Intersubjective relations in which the speech pattern of one subject is stigmatized for another, generating imaginary conditions for constituting a stigmatized image as a speaker. Once configured, such image sustains what has been described as the essence of stuttering.

What is the essence of stuttering?

A subjective state of anxiety and/or fear of producing speech which is frequently followed by the anticipation (and likely visualization) of sounds (letters of the alphabet) or words perceived as problematic, unpronounceable.

What determines the intensity and the sevetity of stutterig?

The frequency with which the state defined as essential is present in the subjective configuration of a person in communication situations, generating a tensioning effect on one or several muscle groups involved in producing speech, thus, materialized as a block and hesitation and/or generating word switching and/or generating frequent silencing.

Stuttering can be prevented?

Yes, starting from the social enlightenment on the effects that stigmatizing intersubjective relations may generate.

Are all the stutterers equal?

Evidently that, as people, it would be inconceivable to state that they are all the same, however, from the point of view of subjective functioning described above, a profound regularity is found among people who stutters.

Is stuttering an emotional problem?

According to our knowledge, stuttering is a consequence of a subjective process marked by a self-image of bad speaker. By considering itself as a bad speaker (a stuttering speaker), the person tries to control its speaking fluency. As the speaking production is, in fact, an automatic activity, trying to control the speech turns the process into something tense that generates a rupture in its flow. This subjective process corresponds to the proposal of the American author Joseph Sheehan: he has detected in stuttering a conflict of approach and avoidance. In other words, the person wants to speak (approach), but by considering itself a bad speaker, wants to control this speech to avoid stuttering (avoidance). In this sense we can say that the production of a stuttered speech involves an emotional conflict, but this is not the same as affirming that stuttering is an emotional problem.

Can stuttering be cured?

If stuttering is, as we propose, a consequence of a subjective process marked by the image of bad speaker, then we can affirm that, yes, it can be cured. It depends on the possibility of generating a self-image of good speaker and by doing so modify the subjective process.

Who cares for stuttering: the phonoaudiologist or the psychologist?

To help stutterers in an effective way, the professional – whatever it might be – must be specialized in studies concerning the problem. By being a speech problem, it is much more related to the phonoaudiologic area and to its object of research. Today, there are an increasing number of studies in this area, as well as the concern in a proficiency of the phonoaudiologist. This expertise requires knowledge of Biology, Linguistics and Psychology because stuttering is a complex problem and understanding it requires proficiency at least in these three areas.

How do you diagnose stuttering?

According to the approach here encompassed, the therapist looks after identifying if the following aspects exist:
1. an established image of bad speaker;
2. the image of bad speaker in development;
3. an absent image of bad speaker.
To do so, the therapist listens to the patient’s description (history) about his/her speech (experiences, feelings, sensations, strategies to speak) observing, at the same time, the body language and the way of producing the speech. If the subject is a child, the parents give this explanation, and the therapist observes the way these parents relate to the child, the way that the speech is produced between themselves, the child’s body and his/her way of producing the speech.

At what age should the parents look after therapy to a stuttering child?

According to our point of view, stuttering might be established from the moment that people (parents, grandparents, teachers and the speaker itself) interpret a child’s speech disfluencies as stuttering. It is precisely this interpretation that can lead the child into constituting the image of bad speaker and, as a consequence, try to control the fluency of the speech, leading to the problem of willing to control something that is automatic. In this case, parents should look for a therapist specialized in problems of fluency as soon as they consider the child’s speech as stuttering. The therapist will help them understand all the biological and psychological process involved in the production of speech and why the child is disfluent.

In the book “The Construction of the Good Speaker Character” you briefly mention the benefits of Yoga Nidra in treating stuttering. Could you develop this subject a bit further – about Yoga - so that more people can also benefit from this information? How important is it in treating stuttering? Which is the difference between this and other types of Yoga?

Let me start with your last question – the matter is not about considering differences between Yoga Nidra and other Yoga, since Yoga Nidra is a part of Yoga in general that is related to the disengagement of the senses. To explain what this means let’s begin by considering that Yoga is union.

Different aspects can approach this concept of union. To the matter here required we are focusing the union between body and mind through conscience (considering mind as feelings and thoughts). To come into contact with this union, Yoga Nidra proposes the conscientiousness of the body to the practitioner, part by part, in a deep relaxation of each part; the conscientiousness of breathing that becomes free, smooth and harmonious until inhaling and exhaling seem to be a single continuous movement; the conscientiousness of what goes through the mind – feelings, thoughts and images – not allowing to be dragged by them but, instead, remaining empty, still minded (if remaining still minded is not possible, lead the mind in being aware of the breathing rhythm). All types of Yoga work with the practise of Yoga Nidra.

The importance of Yoga Nidra in treating stuttering can be understood if we consider that the speaker that stutters – marked by a stigmatized image of himself – has the discursive function stimulated by the desire of controlling the flow of the speech. But the speech flow, as a mater of fact, cannot be controlled. It is a consequence of the meaning that is being built during the discourse in such way that a word “draws” another and they slide from the mouth – so to speak. Producing words is automatic and spontaneous. In other words, we know how to speak, but do not know the way we do it. To fulfil the desired control, the speaker begins to predict where the stuttering will show up (appear / emerge). Usually the prediction of this placing is unconscious - the person just feels that stuttering will happen, knows that will stutter – and is chased by the firm sensation that will certainly stutter.

By conducting speaking experiences lived during a Yoga Nira practice I help patients in becoming conscious of the way their mind works when producing speech and stuttering. They begin to realize and recognize in themselves the moments in which their speech flows free of any control, and when they speak anticipating the place of stuttering. This (The Yoga Nidra practice) allows them to see / feel the intense articulation between foreseeing stuttering and stuck muscles (this articulation is very meaningful, since stuttering is stigmatized and its anticipation could only stuck the muscles in an attempt to restrain stuttering).

The continuity of this practice (experiencing speech by practicing Yoga Nidra) allows patients to slide away from their “mental prison” created by this ante vision of stuttering, engage in ways to “dribble” it, and connect with what is happening to their bodies. This is when they become conscious that their muscles are stuck and this perception allows loosing them.

That is why Yoga Nidra is a technique that allows working, in therapeutic interaction, with the conscientiousness of the relation body / mind either in the production of a stuttering speech, or of a fluent speech and, therefore, help patients to dislocate from the first to the latter.

Can your therapy be applied to childrens well as to adults?

Yes, the therapeutic proposal applies to children and adults because, in any case, it is always related to a pathway that can deliver back to a person the confidence in its own capability of speaking – a capability that is destroyed in communication liaisons that interpret disfluency as stuttering (taking into consideration that stuttering is a socially stigmatized label associated to speaking) – communication liaisons that do not deliver to the speaker the liberty to speak naturally – in its own natural way.

Is there a difference in the treatment between chilfrens and adults?

There are differences between the treatment dedicated to children and adults, because the method used to generate or bring back confidence cannot be the same to adults and children. Each age demands entirely different interactive methods and activities. Moreover, as to disfluency in children, I usually work only with their parents. If they change their way of facing disfluency, if they accept the child as he/she is, this child will not build a self image of bad speaker and, as a consequence, will not regard stuttering as suffering. When the child already has the image of bad speaker embedded in its subjectivity, I usually work with both – parents and child – in order to simultaneously establish that speaking involves fluency and disfluency, with no previous measures of normality or pathology but, on the contrary, always relating discursive contexts that are easier or more difficult to the child depending on the singularity of this child.

Which are the practice phases?

What I propose in my work cannot be applied to phases. The principles that lead my work are already established above: "to give back to the person the confidence in its own capability of speaking". To achieve this goal the therapist needs to be aware to the context, to the speeches produced in each therapeutic session, to the biography of the patient that materializes in his/her speech, to the way that communication liaisons are established with the patient, to the way that communication liaisons are established with the patient parents (concerning children), and how relations are established between parents and their child. All these aspects inspire the therapist actions and speeches that - thanks to a wide range of linguistic and psychologic knowledge about body and mind – are capable of establishing relations that lead the person to confide in its own capacity of speaking.

What role does the environment play in the patient's life?

My understanding is that what has been explained so far clarifies the role of the environment to the patient, especially when I comment about the loss of confidence in the capability of speaking generated in communication relations that interpret the disfluency as stuttering and that, on the other hand, leads to the constitution of the image of bad speaker – embedded in the root of the stuttering as suffering.

How much time has to be dedicated to this treatment?

There is no specific timing indicated to the treatment. All depends on the mental flexibility or stiffness of the people involved in the situation. But, in the case of adults, in average one year of treatment produces noteworthy changes. In children that do not yet have the image of bad speaker rooted in them, usually one session with their parents is sufficient. For those that already have rooted in themselves the image of bad speaker usually require a year of treatment – as adults do.

In how many sessions can one perceive qualitative changes in the patient?

The number of sessions that allow observing qualitative changes vary according to the effects produced in the patient by the therapist's speech and the recommended exercises. It can be weeks or months. But I do always observe significant qualitative changes in the period of one year.