A Funny Thing Happened on the Way to the Secondary Behaviors

This is a follow up to the plan outlined in the previous post.

With the help of my clinician we created a video tape of us having a conversation. Upon watching it I felt two things: disappointment and embarrassment. The disappointment was because there wasn't a lot of physical struggling, the kind that I feel every time I speak for more than a few seconds. I was expecting to feel uncomfortable about watching myself talk, but something else was apparent immediately that I wasn't expecting: I was using a whole heap of interjections. Long strings of "ums" and more individual ones thrown in between words. What bothered me about it, even more than the struggling that I had been looking for, was that, at times, it took away from the coherence of what I was saying. I've always been afraid of that and hear it was, right before my eyes and ears.

So we talked about what to do next. Where do we go from here? One option was to make another recording. I told my clinician that since the ultimate goal of this summer project was to get me to be able to accurately practice my physical secondary behaviors, why not just have me give it a shot, instead of talking and worrying over the tape? I felt that, if allowed to, I would talk around it all day until July came to a close and then I would never have given it a real shot. The part of me that was scared of trying this really wanted that to happen. With my feelings out in the open, we decided that during our next session together, I would just try to voluntarily create some struggling and see where it went. I knew this wouldn't be easy and I wasn't sure if I would be able to make myself do it. Luckily, while walking back to my office after the session, I had an idea for a way to allow myself to get warmed up to the thought of going through with this. And since there was a stuttering group the next night, I had the perfect opportunity to try it out.

The group meeting was lightly attended. It was Jerry, an SLP named J, and a communicative disorders college student named E. I liked being the only person there with a speech problem because it meant I pretty much had a two-hour 3-on-1 therapy session. Selfish, but true. So I presented my idea, knowing that they really couldn't say no to the stutterer at a stuttering group. I had thought up a game that, if all went according to plan, would help to ease me into the practice of voluntarily fucking up my face to match how I uncontrollably fuck up my face all the time. The rules are simple: One person makes a goofy face and then the other people have to all make the same face. Then the next person gets to make a stupid face of their choice while the others get to mimic. The faces can involve some movement and sounds if desired. My plan was that after a few back-and-forths, that I would already be feeling pretty silly about making childish faces, so I wouldn't feel that much sillier jerking my jaw a little to try to simulate what I do while speaking. Aside from me needing to explain the rules several times to Jerry, it went quite well. I felt that there was just the right amount of easing in mixed with a dash of secondary behavior. It produced a number of laughs too.

So the next day at therapy, my clinician and I played the game too. It worked to the extent that it could. I was glad that I gave it a shot and took the initiative to come up with something that would help me try to voluntarily create those behaviors, but it was clear to me that I needed something visual to go off of.

Also, sometime after watching the recording, I had thought a lot about those nasty interjections that I saw and so utterly despised. I came to the conclusion that I've been using them to cover up the physical struggling I'm prone to do. I had undoubtedly used so many of them while having myself taped because I subconsciously didn't want to see myself struggling on the TV. After coming to this realization I noticed that I began to pay more attention to the interjections I was using in my everyday speech and there were times when I really over used them, again, to the point of where I was afraid of causing incoherence. This all gets neatly tied together when we decided to try some casual conversations during my therapy. I immediately liked the results. I was really noticing all the interjections and able to remove a large number of them. And since I was using those "ums" as a way to get myself unstuck or to avoid getting stuck, the outcome of me removing so many of them was that I showed many more instances of physical secondary behaviors – the struggling that we tried and failed to capture during the first taping. So the plan was obvious: Make another recording while having me concentrate on banishing as many of the dastardly "ums" as possible.

We created another recording under the above stated specifications and I really liked results. While it wasn't comfortable watching myself, I didn't feel embarrassed by it either and it showed a significantly higher number of struggling instances than the first one. That's where we sit right now. The next step is to transfer the recording to a digital format so that I can watch it more on my own and see what I think of it and to get comfortable with seeing myself do those things.

And it's out of context in regards to how it's said in the song, but I relate these lines to making a decision to break old habits and to form new habits.

Drive until you lose the road
Or break with the ones you've followed

http://www.youtube.com/watch?v=TmFi2snLr7o

I want to be like Mike

I hope he doesn't mind me talking about him and I hope he corrects any incorrect characterizations I might have made.

Mike is a friend of mine. Mike is an SLP. Mike is a stutterer. Mike is a former stutterer. When Mike talks about speech, he does so like no one else I've heard before. This is true because he speaks from his own experience coping, struggling, overcoming, anguishing, surviving, helping, learning, teaching. I don't always understand the importance or the depth of what I'm hearing, but I listen and try to absorb as much as possible because as different as we are, we're the same in the ways that matter for the topic of stuttering. Mike is the one that affected me profoundly with a single sentence, as chronicled here. Mike used to stutter. And by that, I don't mean some nice, simple repetitions, I mean the whole facial tension, twisting of the head type of stuttering. I know this because he's not only talked about it, he shows people exactly what he used to do. He can demonstrate his struggling whenever he wants to. He is exerting control over his speech by making mistakes at the time of his choosing.

I'm at a point in my therapy where it's great because I'm aware of blah blah blah. I realize my irrational fears, my idiosyncrasies, blah blah blah. I've also realized that I'm at a point where I'm comfortable. Being comfortable isn't a bad thing, but if I stay in that cozy spot and never push myself beyond it, then this is as far as I'm going to get.

A month or so ago, I talked to Mike on the phone for awhile. He explained that one of biggest positive steps he took in his therapy was confronting his struggling. He did this by being able to mimic at will his worst secondary behaviors. He suggested I do the same thing. His idea was this: Get a recording of me that shows a range of my worst struggling. Watch that recording over and over so that I become desensitized to seeing myself doing those abnormal things that I do everyday. Take note of what I don't like the most about it and practice doing those things so that I can eventually do them whenever I want. The point of it would be for me to able to have total control over my speech, so that I know I can act out those struggles when I want to. It's a way of confronting a fear and coming to a better understanding of my speech.

Right now I'm actually more nervous about properly producing the recording of my struggling than I am of trying to bring myself to voluntarily repeat those struggles. I'm afraid that there will be technical problems (we'll be recording to tape and since I don't own a VCR, we're going to try to transfer it to a digital format). I'm afraid that I (or my clinician) won't feel that what we recorded is a very good show of the worst of my worst. My fears are being a little magnified because I only have about seven weeks left to work with my current clinician and I want to get this recording right the first time so that we can spend as much time as a possible on the real meat of the task. I decided to write about this right now because we're going to be going at this for the first time on Thursday. Talking about it beforehand ensures that it's out there, i.e. I can't back out as easily if it really sucks.

But really, how bad can it be? All I'm trying to do is force myself to do something voluntarily that I do all the time anyway.

Hypothetically Hypocritical

Slow down! Take a deep breath! Calm down!

These three things are often said to someone, in particular a child, who is starting to repeat their words. The person offering the ill-advised advice is often a well-meaning parent or teacher. The advice is so profoundly wrong because the child is probably doing something, developmentally, completely normal, but that child is now slowly coming to the conclusion that they are doing something terribly wrong and that it needs to be corrected. Overcompensation, internalizing, and fear lead to real problems, like stuttering or the worst outcome – silence. My speech problem, while not due to being told those three exclamatory utterances, is a product of internalizing fear and keeping that fear tightly tangled together with my speech.

Someone talking too fast doesn't cause stuttering. Someone not breathing enough during their speech doesn't cause stuttering. Someone being overly excited about the topic they're talking about doesn't cause stuttering. Others may not know this, but I do.

Now, to the point! I enjoy the fact that I'm now much more conscious of many more aspects of my speech while I'm speaking and it's opened my eyes to some interesting things. But despite my strong words in the preceding paragraphs, I find myself thinking I really need to just slow down, breath more during speech, and calm the hell down. And then I wonder how big of a hypocrite that makes me.

So in the context of therapy it's like this – Do I work those three things in somehow? Do I ignore them and just deal with things much more underlying? Talking fast, being over-excited while speaking, and talking until you're out of breath can certainly cause anyone to stumble on their words and I know those things sometimes help send me into struggling mode. But the difference between me and others is that even if all three of those factors are absent, I'll still struggle. So is improving in those three areas worth it because it could allow me to strip down my speech to something easier to work with or is it just a waste of time and setting myself up for disappointment?

In any case, it's a good thing that I'm acknowledging this. Go me!

And lastly, I've been listening to this lovely song a lot:
http://www.youtube.com/watch?v=QotZ7TIaztw
(It doesn't have anything to do with faulty speech production.)

At Least I Didn't Wait a Full Three Months

My motivation for finally getting something posted here was several people actually telling me that they've been looking every once in awhile and there hasn't been any updates. Thanks for the little shove.

This post won't make total sense unless you've read my previous couple of posts (and even then, I won't guarantee that it does...).

I came to a conclusion. Before I get to said conclusion, I'll recap how I reached it. During the end of the summer in therapy, while I was working on the repetitions (see previous posts), my clinician called me out on something. She told me that she could guess, quite accurately, which words I was going to use a voluntary repetition on. This struck as not-so-good because it looked like I was falling into a pattern rather than just randomly choosing words.

That pattern was me subconsciously avoiding words that I could not stre-ehhhhhhhh-tch out the sound, but that, because of the nature of their sound, could only repeat them. Here, you folks at home, give this a shot: Choose a letter and make that letter's sound for several seconds. Try it with any of the following: w, r, l, n, m, y. You can keep your mouth in one position and keep making the same sound until you run out of breath (or until someone slaps you on the back of your head). Now try the same thing with some of these letters: b, d, g, t. As soon as you make the initial sound, it's done. Extending it is just some superfluous vowel sound and not the sound anymore that actually classifies it as that letter's sound. The wwwwwwater is d-d-d-down nnnnnext to the b-b-b-boat. I can do the w and n just fine but the d and b cause me to struggle.

So the conclusion that I came to through all of this is that I'm still avoiding the sounds that demand repetitions and focusing on what comes easier - prolongating the sounds instead. For Halloween, I think I'll dress up like a repetition, since there's apparently nothing more frightening.

Sometimes while reading aloud in therapy I'll try to use repetitions on all the b words just because for some reason the bah-bah-bah sound is much harder for me to do. It frequently doesn't work out as planned and I'll kind of freeze up on the sound, but sometimes it goes just fine. I have no idea why. Also, I must say, whoever thinks it's a good idea to put two b words in a row can go straight to hell, the barbaric bastards.

Something W-w-w-icked This Way Comes

This post ties in well with this one.

Because it's done at a university, a year of therapy for me consists of three different periods of time - Fall semester, Spring Semester, and June and July during the Summer session. During this past Spring Semester, for the first time, I started really playing a more direct role in making changes to my therapy. I've always had a say, and I've always been ok with what we were doing, but this time we (my clinician and I) worked and we changed things based on what I said.

We worked hard at the end of Spring semester and into the Summer because I felt I was moving towards the verge of somewhere good and I needed to get the details of what we were doing hammered out before the end of the Summer. When the Fall semester starts, I'll be getting a new clinician and I wanted a therapy plan in place that I felt good about and one that was explained thoroughly enough to be clear as to what we were doing and what my goals were.

We developed a plan to talk about certain topics, topics that are important to me and/or affect me emotionally. After having a conversation about such a topic I would then talk about how I thought my anxiety level was, how I thought the setting affected me, and how much I thought I struggled throughout the conversation. The idea was that talking about these things would help us to figure out if there were any correlations to the topic, my emotional state, outside influences, etc. On top of that, it was going to be a time where I could practice talking about those hardest of subjects, feel what's going on inside me at those times (fear), figure out where it's coming from (What am I afraid of and why?), and try to change it (get rid of the fear). In my head, this was going to be the new centerpiece of my therapy and this would carry into the Fall semester with my new clinician.

Then after working on this for a few weeks, we started trying something else in therapy, besides the conversations and discussions I just mentioned. I don't remember what exactly started it, maybe it was the Dairy Queen blog post that I linked to at the start of this post, but in any case... I knew I couldn't force myself to use natural repetitions in my speech because I would subconsciously use tremendous energy to avoid them. Well instead, I gave it a shot while reading aloud to my clinician. The theory was that this would be much easier for two reasons. First, because I don't stutter much while reading - so instead of adding repetitions as well as my normal struggling, I'm just dealing with adding repetitions. Second, because of the nature of reading, I can see exactly what's coming up and periodically choose to repeat a word.

The first few times reading aloud with repetitions were very uncomfortable and I felt really stupid doing it and I also felt an irrational feeling that what I was doing was wrong. Because I felt that way, I was shocked at how fast the uncomfortable feeling subsided. I remember that at one point during one of the first readings, after it started getting easier, I got a little smirk on my face. The smirk was actually me holding back laughter. If I hadn't kept it in, it would have been the kind of laughter that is raw and emotion filled. Like when you're waiting for something really bad to happen, it doesn't happen, and then you realize it's not going to. Happiness was certainly a main proponent of the emotion, but far from the only one. Relief, a major feeling of liberation, and maybe a smidge of "This is all it took? I could have done this years ago." were all present too.

After that, the repetitions in reading had gotten much easier and so we moved to bigger and better things, i.e. a more public place. We sat in a computer lab (although not a very busy one) with me reading a news article aloud to my clinician while other people were around (although not all that close). After a few sessions of that, we modified it a bit so that after reading a short article we would then talk about the article while I continued the repetitions, i.e. trying to make a transition from the repetitions in reading, which were now easy, to the repetitions in casual conversation which I had never been able to accomplish. It was very hard to make myself incorporate repetitions into that speech, but I was able to manage to get a few.

During this time I also read aloud a few times at home to my wife. The first time, this was very uncomfortable and I read for several minutes before I was able to bring myself to toss in a repetition. The next time we did it, it wasn't so bad and I ended up reading about the exploits of Scarlett and the gang for nearly a half an hour.

Back in therapy we decided to take it a little further and walk through campus and casually talk while I would use repetitions instead of struggle, i.e. when I felt like I was going to start to fight to get words out, I would instead (in theory!) just use repetitions in place of the struggle. The first session of doing this I still struggled quite a lot and didn't do a very good job at getting the repetitions in there. The second time was much more successful and was a large improvement in the number of repetitions I was able to use while being out-and-about.

So the therapy I explained near the start of this post, with the three categories, I said I had planned on it being the new centerpiece...well now I feel even stronger that this, these repetitions are the true centerpiece that everything else must be built upon. There are a number of things I've done in therapy so far that I've felt good about at some levels, but I could not fathom how they would ever translate into positive improvements in my everyday speech. Now I've realized that many, if not all, of these things (including the "three categories" idea discussed earlier) should be re-looked at and re-evaluated later in my therapy, at a time when I would be able to properly use them to help my everyday speech. It's not that any of these things were bad or worthless, I just wasn't ready for them yet.

So the wickedness coming this way are the repetitions that I feared 20+ years ago and have since built all of my struggling speech habits on top of.

My Ears are Proud and Collision is Such an Ugly Sound

"Every minute is arranged, every moment lasts a day. Thinking about it can't help me let go, I know." -- Jim Adkins, Jimmy Eat World

So I was thinkin'...when I do these quote posts, maybe I should write up an explanation. I first thought about doing this when my clinician asked me to explain why I had chosen the last quote. After I ended up talking about it for about twenty minutes I realized I had a lot to say about it.

Like poetry, song lyrics can usually be interpreted in many different ways. Sometimes you can find meaning in just a single phrase that may mean something totally different when looked at with the other words around it or when heard by someone else. What I'm saying is, this quote is most likely taken way out of context, but really, who cares? It means something meaningful to me (even if the song has some lame "ha ha ha's" in it.).

The first part is just simply about how most people don't realize the vast amounts of pre-stuttering preparation that goes into making an eye-twitching, facial-contorting, no-sound-coming-out-while-everyone-waits, overall freakish moment not just good, but great. (That's one of those "laughing at myself on the outside and crying on the inside" type of sentences, but really, don't worry, it's more laughing than crying.)

The second part is about how I think about things all the time and analyze everything until every angle is thought about. Sometimes that's a good thing and sometimes it's just an exercise that helps me pretend like I'm getting somewhere when I'm actually not doing a damn thing. But to keep this strictly about speech production - it's good that I think about my speech and everything entailed in that, but at some point it needs to lead to action if any real changes are going to be made. And not just action, but me letting go, not caring what other people think, realizing my fears and overcoming the irrational ones. Another quote from the same song ties in well with this: "Gotta love how it's somehow all on me." I have people who are willing to help me and have put a lot of effort into helping me, but it all comes down to me (as well it should and as well it has to). That's something else I have to deal with.

The title of this post is actually a line from the song too. "Collision" is obviously my total struggle while trying to talk. While I'm obviously used to the way I talk, it's still no fun having to go through it all the time. And since I am a fan of brutal honesty, I won't cringe at calling my struggling ugly. I should just be glad it's just my ears I have to deal with and not my eyes too.

After reading through this, it may come across as negative, but fear not! I like where I am right now.

Two Stutterers and a Speech Therapist Walk into a Dairy Queen...

Time slides by quickly
Letting it pass is easy
Seizing it is hard

This month the stuttering group was lightly attended. There were three of us there: Barry* the speech therapist, Mick* the life-long stutterer, and me. We talked for awhile and then watched a short video with information and interviews about the Monster Study. After that, Barry wanted me to try something. He wanted me to try to speak more carelessly so that instead of the tension, words would come out with the normal type of repetitions that everyone makes in their speech. I’m certain that he wasn’t expecting fabulous results, but it could help to show me some examples of speaking without trying so hard. As I’ve experienced in therapy, when I start speaking with the idea of replacing tension with repetitions, no tension or repetitions come out, only normal sounding speech. I explained this to Barry, saying that when I get told to just let the repetitions happen, I usually speak just fine. Barry disagreed. He asked me if I was trying hard at times like that. I only needed a moment of thought before I said that yes, I was trying hard, very hard. He said that what I was doing was producing normal sounding speech while still struggling inside and backing myself up against a wall. We talked about that a little more and then, since there were only three of us, we headed to Dairy Queen. While there we talked some more and Mick and I tried to keep Barry from making a scene, which he probably does a lot when he’s not properly supervised (Anyone who knows Barry, knows exactly what I mean.).

It wasn’t until the next morning that I made some connections with what Barry had said the evening before. His mention of “backing myself up against a wall” was something that I had done over twenty years prior. After I had been in speech therapy as a child for awhile for non-stuttering issues, my mom had reported to my speech therapist that I was stuttering at home. The therapist blew her off and said that she was not seeing anything in the therapy so not to worry about it. What I undoubtedly was doing was trying really hard in therapy to speak without any errors. Sometime during that period I became aware of my imperfect speech and afraid of making errors, even errors that are completely normal for a six-year old and errors that no one would even really notice. Now, jump back ahead to my current (s)peachy predicament - anytime I’ve been asked to purposefully have normal repetitions it feels very uncomfortable and just plain wrong. If I’m asked to just let repetitions happen as they naturally would, I unconsciously try very hard not to have them, and back myself into that wall - the wall being the tension and secondary behaviors that I have today. I might be able to speak error-free for awhile if I try really hard, but at some point, simply trying hard won’t be good enough, which leads to trying harder with limited results, which leads to trying harder still with even worse results, etc. After awhile I’m left with facial tension, closed eyes, and the rest of the craptacularly abnormal things I do while trying to force my speech.

In summation, it is my subconscious and irrational belief that normal speech repetitions are the root of all evil. I should really get over that.

*The names have been changed to protect the innocent, or in Barry’s case, the not-so-innocent.