As a chronic avoider of stammering for most of my life I recently became attracted to the work of American stammering therapist, the late Joseph Sheehan, and to his hypothesis that the more you get rid of avoidance the nearer you will attain fluency. As a result he developed a tough therapy which he felt necessary for success and one of his key concerns is this respect is the adjustment to fluency that needs to take place for the stammerer. He is also very concerned about the qualities of a therapist and their role in the success of therapy. All in all I believe he is a man with impressive credentials and one well worth listening to.

Adjustment to fluency is a very important concept in his therapy. Psychologically you are so used to being a stammerer (even though you may hate it) that when you become more fluent in therapy the CHANGE can be resisted (many people find change threatening). This can even result in the sabotage of your own gain.

I'm sure many stammerers suffer from the 'Giant in Chains' complex in that they think they will achieve great things once they get rid of the stammer which they consider has been holding them back. Sheehan is very wary of such hopes and reckons that there are two ways to be disappointed in life - one is to never get the things that you wish for, the other way is to get them! If you do attain fluency this will often uncover other areas of weakness in yourself. Once your stammering has lost its defensive function you attain parity with everyone else - but you then have to compete with them on equal terms! As an example of this one of Sheehan's clients felt that he wasn't popular because he stammered, but he discovered to his dismay that when fluent, people didn't like him anyway. It can be at this point for some stammerers that the hard work begins and you have to take and honest look at yourself. I think we must recognise that fluency can cause problems and they have to be dealt with.

As a therapist himself he emphasises the fact that success in therapy depends on the therapist as well as on the stammerer and that such an outcome is best delivered by a person with knowledge and expertise in psychotherapy as well as in stammering therapy. I feel that this would be a good model for both the NHS and private 'alternative' therapists to work towards.

For non-stammering therapists he reckons that acting the role of the stammerer has no parallel in understanding the psychology of stammering. I am fortunate in having had a therapist whom I know has been willing to do this herself. Unlike this country many of the speech pathologists in America are stammerers and therefore not surprisingly seem mainly to be men.

As a psychologist Sheehan offers many insights into stammering and its therapy. He recognises that stammerers will resist therapy (not always for the wrong reason - it might not be the right therapy) and that some stammerers will not progress until they work on their own without a therapist.

He is also aware that there are many sources of discouragement for a stammerer in therapy ie. he can feel guilty for not doing well enough or can feel hopeless in his ability to change. All such areas must be dealt with by the therapist. He sees the cardinal elements in therapy as empathy, hope and challenge. He also talks about the importance of the correct demand/support ratio from the therapist. The successful formula being low demand and high support and not the other way round - high demand and low support, which will be unsuccessful.

On a personal level following Sheehan's advice has helped me tremendously. One problem that he raises in avoidance reduction therapy is that often the client cannot readily see progress whilst he is in the midst of making it. He has lost sight of how he was - yet he cannot really see how he will be. I must say I went through this myself but now believe I am through it. I might stammer a lot more now but at least I can talk when I want to!

I have also been preoccupied with the fact that I might stammer for some 'purpose' and this has made me feel bad at times. However Sheehan's experience is that any secondary gain a person gets from stammering (like not having to speak in public etc) is not greater than the primary loss of not being able to talk and this has been nice to know.

In the overall analysis I feel Sheehan is a tough talker who knows what he is talking about. He expects you to experience fear in therapy and feels that it is the only way you will make progress. He considers that talking about your feelings is fairly easy - what is difficult is doing something in response to them.

From the Spring 1990 issue of 'Speaking Out'.