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What causes stuttering?

Stuttering does not have a direct cause. It consists of patterns of interaction in which only the verbal aspect of speech is valued and communication is neglected. Example: a child says: le le le let me get another one up there mommy? and the mother answers something like: be calm; breathe before speaking; speak slowly; think before you speak. In this interaction, a) the adult did not let the communication flow, because he did not respond to what the child asked b) and made a reference to the way the child spoke, suggesting that he should speak again and in another way. This suggestion: 1) is too abstract for a child to effectively know what to do with his speech; 2) rejects his way of speaking; 3) it can make him consider his speech is ugly, bad, undesirable; 4) it can generate fear and shame of the way of speaking; 5) it can awaken the desire to control his own speech to avoid further rejection. As speech is an automatic and spontaneous activity, the desire to control it, associated with fear and shame of the way of speaking, affects the automatism, producing tensions in the phonation muscles. A child who repeatedly experiences this type of interaction pattern, could build a stigmatized image as a speaker and automate the need to control his way of speaking. This, as mentioned, generates tension in the speaking muscles, constituting a speech with stuttering.

What is the essence of stuttering?

A subjective state of shame and fear of speaking spontaneously, accompanied by the prediction of sounds, words or expressions that appear to be problematic, dangerous, unpronounceable.

What determines the intensity and the sevetity of stutterig?

The intensity and frequency of shame, fear and the prediction of dangerous places in speech, which can lead to: 1) severe stiffness in pronunciation; 2) not to say what is actually intended; 3) silencing.

Stuttering can be prevented?

Yes, starting from the social clarification on the effect of interactions in which only the verbal aspect of speech is valued and communication is neglected. Also from the social clarification on the fact that it is perfectly normal for the child to be very disfluent, because, as he is developing his vocabulary and his ability to use the rules of the spoken language, the words or verbal expressions can momentarily be missing and the child, without embarrassment, fills this places by repeating sounds, syllables or making sound extensions.

Are all the stutterers equal?

As people, of course, it could never be said that everyone is the same, however, from the point of view of the subjective functioning linked to speech, there is a profound regularity among people who stutter, as described above.

Is stuttering an emotional problem?

Yes, since the stuttered speech pattern involves a stigmatized image of a speaker that generates feelings of fear and shame to speak in public, feelings of inferiority in relation to other speakers, avoiding communication situations, showing great emotional suffering connected to the act of speaking.

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?

In order to effectively care for the person who stutters the professional, regardless of the area, must have specialized studies on the nature and treatment of speech fluency disorders. Because it is a phenomenon that manifests itself in speech / communication, it is more accustomed to the speech therapy field and its research object. Specialized training involves knowledge of anatomy, linguistics and psychology, because stuttering is a complex problem whose understanding involves at least knowledge 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 view, stuttering gains the possibility of settling in the moment people (parents, grandparents, teachers, the speaker himself) interpret the speech disfluencies as being a problem. This interpretation can lead the child to constitute an image of a bad speaker and, consequently, to try to control his fluency, thus leading him to the problem of wanting to control what is automatic. Under these conditions, parents should seek a specialized therapist in fluency disorders as soon as they consider that the child has a stutter. The therapist will help them to understand the whole organic, linguistic and psychological process involved in the production of speech and to understand why it is normal for a child to be 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 which refers to the construction of a deep state of psychophysical relaxation. 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 1) the conscientiousness of the body part by part, deeply relaxing each one; 2) the conscientiousness of breathing that becomes free, smooth and harmonious until inhaling and exhaling seem to be a single continuous movement; 3) 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. When staying with an empty mind is not possible, staying with the mind conscious of the rhythm of the breath. All types of Yoga work with the practise of Yoga Nidra.

The importance of Yoga Nidra in dealing with stuttering can be understood if we think that the speaker who stutters, marked by a stigmatized image, has the desire to control the flow of his speech. But the flow of speech is not subject to control, it is automatic, [it stems from the meaning that is built up throughout the speech, in such a way that] one word "pulls" the other and they go, so to speak, slipping from the mouth. In order to achieve the desired control, the speaker starts to foresee the place where his stuttering will appear, that is, he feels or sees that he will stutter, knows that he will stutter, the sensation that he will stutter pursues him and this tenses the muscles involved in speaks actually producing stuttering.

From the practice of Yoga Nidra, I help the patient to become aware of the way his mind works in the production of speech and in the production of stuttering. He begins to perceive and recognize that it flows in the moments when he lets himself speak freely without controlling and stutters in the moments when he speaks anticipating the place of stuttering. This allows you to see / feel the strong relationship between anticipating stuttering and locking muscles.

The continuity of this practice allows him to understand that at the moment of the crash he can focus on what is happening in his body, in his muscles, instead of being in the "mental prison" formed by: fear of stuttering, anticipating stuttering and trying. The concrete perception of the body and muscles allows you to release the locks easily.

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 approach applies to both children and adults. In both cases, it aims to make the person regain confidence in his ability to speak spontaneously.

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

There are many differences. Each age requires very different modes of interaction and activities. In addition, with regard to childhood disfluency, work is often only with the parents. If they change their way of looking at disfluency, if they start to accept it, the child will not build an image of a bad speaker and consequently the stutter will not be built. If the child already has an image of a bad speaker installed in his subjectivity, I work together with the parents and the child, so that everyone can accept that both the flow and the disflow are natural parts of communication and can understand that the focus should be keep in communication between the child and others and not exclusively in the child's verbal expression.

Which are the practice phases?

The guiding principle is to build trust in the ability to speak and communicate. For this, the proposal moves along three axes that intertwine: 1) The development of the ability to understand and feel concretely everything that occurs in the body during the act of producing speech. This allows the patient to recognize that his ability to speak is ok; 2) The development of the ability to understand and perceive the relationship between the body and the mind during the production of stuttering, as previously described, that is: fearing and being ashamed of stuttering leads to foresee it and to foresees it creates blocks, escapes and silences. This allows the patient to be fully aware of how stuttering is produced; 3) The development of the ability to welcome stuttering and give time for it, instead of rushing, using tricks and fighting not to stutter or run away from speech. This allows the patient to radically change his pattern of social interaction by reducing suffering during speech and leading to fluid communication.

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

Having a stigmatized image of a speaker, the environment, especially the parents look, represents a trigger for fear of stuttering and everything that follows.

How much time has to be dedicated to this treatment?

The duration of therapy depends on the patient's greater or lesser mental flexibility. For adults, an average of one year of treatment produces significant changes. For children who do not have an internal image of a bad speaker and have parents who are receptive to accepting disfluency as a natural part of fluency, a single meeting with the parents may be sufficient. This changes a lot when parents do not accept disfluency as natural, which can lead to an indefinite duration of therapy. Children with this internalized image may improve in a few months of therapy, but they will also depend on the parents' ability to accept their speech pattern for a more definite improvement.

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

This is very variable because it is a subjective approach and, as stated above, depends on the patient's mental flexibility. When there is flexibility, significant improvement can occur in the first two months of therapy.