Understanding Stuttering and Counseling Clients Who Stutter

Stuttering is a complex and prevalent disorder that involves not only speech disfluency but also challenging psychological and interpersonal experiences for those who stutter. Difficulties are exacerbated by fluent speakers' misconceptions about stuttering and negative attitudes toward people who stutter. As counseling techniques have been found to be effective in the treatment of stuttering, counselors must be better educated about stuttering and how to work effectively with clients who stutter. This article presents counselors with a model of stuttering that highlights three primary aspects of stuttering from a client-centered perspective. These three components of stuttering--struggle in speaking, avoidance of cues associated with speech difficulty, and the expectancy of speech difficulty--are each described with theoretical, empirical, and anecdotal support. Evidence of the effectiveness of counseling for stuttering is provided along with general guidelines for counselors working with clients who stutter. Studies have continually reported that the general public, and even speech pathologists and teachers, tend to have inaccurate knowledge about stuttering and often hold negative attitudes toward people who stutter (Ginsberg, 2000; Lass, Ruscello, Pannbacker, Schmitt, & Everly-Myers, 1989; Wirtz, 1992; Yeakle & Cooper, 1986). This uninformed and frequently negative view of stuttering has itself contributed to the problems faced by those who stutter. Although people who stutter are, on average, no different from the general population in terms of psychological health and personality (Bloodstein, 1993), stuttering is a condition that is often accompanied by emotional distress (Manning, 1999), which is exacerbated by the incorrect and unflattering assumptions generally held by the public. When the individuals possessing negative perceptions are mental health professionals from whom those who stutter may receive counseling, the consequences can be devastating. Unfortunately, it is not uncommon for people who stutter to have had experiences with counselors who possessed little knowledge about stuttering, and in the worst case scenarios, were wedded to outdated theories and stereotypic assumptions. People who stutter have been labeled by their (typically well-intentioned) counselors as nervous, uptight, unintelligent, socially inept, and maladjusted. As the prevalence of stuttering is approximately one percent of the adult population, with higher numbers in childhood (Bloodstein, 1993), it is likely that at some point in their careers counselors will encounter a client who stutters. Accordingly, counselors should be well prepared to assist those who stutter rather than add to their difficulties. Moreover, the value of a well-informed counselor can go beyond the emotional well-being of the person who stutters. The self-perception of an individual who stutters is thought to be a critical influence in the perpetuation of a cycle that either maintains disfluency or promotes greater facility in speaking (Harrison, 1993). Indeed, in one recent study, feelings of shame and self-consciousness among people who stutter were found to be related to more severe stuttering behaviors (Patraka, 1998). Thus, if properly prepared, counselors can not only contribute to their clients' emotional well-being, but they can also assist their clients in achieving greater fluency. To accomplish this, counselors need to better understand the stuttering phenomenon, with particular attention to the perspective that their individual client has of his or her stuttering problem. Although much about stuttering, including its etiology, continues to be debated by experts in the field, certain components of stuttering are generally accepted and can elucidate the experience of stuttering considerably. Accordingly, in this article, a prominent model of stuttering based on principles of learning theory is presented with a focus upon areas relevant to the counseling process. …