Walter H. Manning

Coping responses by adults who stutter: part I. Protecting the self and others.

UNLABELLED Using a grounded theory approach, four clusters were identified that represent patterns of coping by adults who stutter. In order to understand the complexities within the coping responses of speakers to the experience of stuttering, this first of two companion papers summarizes the literature on the human coping response to stress and the nature of two of the four main findings identified. These findings describe a coping process that emphasizes strategies of protecting both the speaker and the listener from experiencing discomfort associated with stuttering. The companion paper describes the remaining two main findings that emphasize the characteristics of self-focused and action oriented coping responses. EDUCATIONAL OBJECTIVES The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with the process of coping with stuttering, (2) describe the basic rationale for the procedures associated with grounded theory methods, (3) describe the factors that influence the choice to use emotion-focused and problem-focused coping strategies, and (4) explain the factors that contribute to the use of methods of escape.

Coping responses by adults who stutter: part II. Approaching the problem and achieving agency.

UNLABELLED As with the first of two companion manuscripts, this investigation employed a grounded theory approach to identify patterns of coping responses by adults responding to the stress resulting from the threat of stuttering. The companion paper described emotion-based avoidant coping responses that were used to protect both the speaker and the listener from experiencing discomfort associated with stuttering. This paper describes two cognitive-based approach patterns that emphasize self-focused and problem-focused forms of coping. The first of the cognitive-based coping patterns involved speakers approaching stuttering with a broader perspective about themselves and the experience of stuttering, resulting in an improved self-concept and increased self-confidence. The second coping pattern involved speakers focusing on their own goals which results in increased agency and self-confidence. Participants described the development of more functional coping responses. They moved from emotion-based avoidant patterns of coping that focused on protecting the self and the listener from experiencing discomfort associated with stuttering to cognitive-based approach patterns that focused on the needs of the speaker. As the participants chose to approach rather than avoid or escape stuttering, they experienced many positive social, physical, cognitive, and affective results. EDUCATIONAL OBJECTIVES The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with the process of coping with stuttering, (2) describe the basic rationale for the procedures associated with grounded theory methods, (3) describe the factors that influence coping choices, and (4) explain the factors that contribute the use of approach-oriented and agentic coping strategies.

A personal construct psychology view of relapse: indications for a narrative therapy component to stuttering treatment.

UNLABELLED Relapse following treatment for stuttering is a common problem for many clients. It has often been suggested that one factor contributing to relapse is the clients difficulty in adjusting to a new role as a fluent speaker. In this tutorial article, we first present a personal construct view of relapse, which suggests that this difficulty may be addressed by increasing the meaningfulness of the fluent speaker role for the speaker. Section 3 proposes that post-treatment success for persons who stutter may be facilitated by the use of a narrative approach to counseling in which the meaningfulness of the fluent speaker role is elaborated. In this approach, clients are guided through a process of deconstructing their stuttering-dominated personal narrative, followed by the reconstruction of an alternative narrative that is more compatible with being a fluent speaker. EDUCATIONAL OBJECTIVES The reader will (1) learn about a personal construct psychology perspective on resistance and relapse in stuttering therapy, (2) be able to describe a narrative approach to counseling for people who stutter that is directed toward the long-term maintenance of fluent speech and the steps of deconstruction of the dominant stuttering narrative and reconstruction of a new, more fluent personal narrative, and (3) be able to prepare a series of narrative interview questions with which to engage clients in conversations that may facilitate the deconstruction and reconstruction processes.

Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering

UNLABELLED The treatment components that contribute to and account for successful therapeutic outcomes for people who stutter are not well understood and are debated by many. The purpose of this phenomenological study was to describe in detail the underlying factors that contribute to a successful or unsuccessful therapeutic interaction between clients and their clinicians. Twenty-eight participants, 19 men and 9 women, who had received from 6 months to more than 12 years of therapy for stuttering were studied. The participants were asked to consider their experience with one or more speech-language pathologists with whom they had received fluency therapy and to describe the characteristics that made that individual effective or ineffective in promoting successful change in their ability to communicate. Analysis of these data resulted in 15 primary categories. Finally, the essential structure of an effective and ineffective therapeutic interaction was described. Results highlighted the importance for effective therapy of understanding the stuttering experience, forming a positive client-clinician, alliance, and being knowledgeable about stuttering and its treatment. EDUCATIONAL OBJECTIVES The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with an effective therapeutic interaction, (2) describe, from the perspective of a select group of adults who stutter, the themes associated with an ineffective therapeutic interaction, and (3) describe the ways in which an effective or ineffective therapeutic interaction could impact a person who stutters.

Attitude and personality characteristics of older stutterers

Abstract Attitude and personality characteristics of 29 stutterers (19 male, 10 female) aged 52–82 yr were assessed using five questionnaires. Results indicate that, while the older stutterers score approximately the same as young adult stutterers on scales assessing approach and performance behaviors, the large majority of older stutterers perceive their stuttering as less handicapping than when they were young adults. Self-perceived personality characteristics of the older stutterers were similar to a group of older nonstutterers. While a few of the subjects had experienced some degree of success as a result of treatment later in life, the majority of the subjects did not currently desire treatment.

Fluency breaks in older speakers: Implications for a model of stuttering throughout the life cycle

Abstract In order to test a model describing the occurence of fluency breaks throughout the life cycle, spontaneous speech samples of 40 nonstutterers and 4 stutterers above the age of 50 were perceptually analyzed. Fluency breaks were classified into categories of formulative or motoric breaks. The results supported research, noting an increase in formulative fluency breaks (especially fillers and interjections) for older speakers. There was, however, a significant decrease in the occurence of formulative fluency breaks during the final years of late adulthood. No change was found in the occurence of motoric fluency breaks in the nonstuttering speakers. Stuttering speakers had significantly less formulative breaks and significantly more motoric breaks than nonstuttering speakers.

Documenting changes in adult speakers’ locus of causality during stuttering treatment using Origin and Pawn scaling

UNLABELLED The concepts of locus of control and locus of causality are similar and refer to the degree to which a person perceives daily occurrences to be a consequence of his or her own behavior. Locus of control is considered to be a unidimensional construct indicating an inverse relationship between the polls of internality and externality. The locus of control is generally determined by using questionnaires with a limited number of items. Locus of causality is considered to be a two-dimensional construct where Origin and Pawn values, which are similar to internality and externality, respectively, are not necessarily inversely related. Locus of causality is determined by content analysis of freely spoken or written narratives. In the current study Origin and Pawn scores were obtained from twenty adults prior to and following a three-week intensive stuttering treatment program. Brief narratives written by the participants were analyzed to obtain Origin and Pawn values. These scores were compared with traditional measures of therapeutic outcome (Locus of Control, OASES, PSI, percentage of syllables stuttered). Results indicated statistically significant increases in pre- to post-treatment Origin scores (p=.001; Cohens d=1.44) and statistically significant decreases in pre- to post-treatment Pawn scores (p=.003; Cohens d=1.11). Origin and Pawn scores showed significant relationships with other measures of stuttering, indicating concurrent and construct validity. Origin and Pawn scaling procedures appear to provide a valid, sensitive, and nonreactive indicator of the speakers locus of causality and ability to develop an autonomous and agentic lifestyle. EDUCATIONAL OBJECTIVES After reading this article, the readers will be able to: (1) distinguish between the concepts of locus of control and locus of causality, (2) describe the characteristics of individuals behaving as an Origin and a Pawn, (3) differentiate patterns of change for Origin and Pawn scores prior to and following treatment, and (4) describe the clinical advantages using Origin and Pawn scaling procedures for individuals who stutter.

The role of psychological processes in estimates of stuttering severity

PURPOSE To examine the associations of trait anxiety (STAI), social anxiety (SIAS), depression (BDI-II), and personality features (ADP-IV) with three measures of stuttering severity: %SS, Stuttering Severity, Instrument, and the Overall Assessment of the Speakers Experience of Stuttering. METHOD Fifty adults with a history of stuttering served as participants. Participant scores on trait, anxiety, social anxiety, depression, and personality features were entered into a regression analysis, with the criterion variables (DVs) being: %SS, SSI-3, OASES total score. In order to explore the OASES, further, each of the four OASES subscales were also examined. A separate regression was conducted for, each dependent variable. RESULTS The OASES total score model was significant (p<.0001) and revealed that social anxiety and, trait anxiety were the only significant predictors, with medium effect sizes noted for both variables. In contrast, percent syllables stuttered and the SSI were not significantly associated with psychological, variables, suggesting that anxiety may not always be related to overt indicators of stuttering. Depression and personality dysfunction were not significantly associated with any measure of, stuttering severity. CONCLUSION Anxiety in the form of social and trait anxiety are significantly associated with stuttering, severity as indicated by the OASES. Traditional procedures for assigning severity ratings to individuals, who stutter based on percent syllables stuttered and the Stuttering Severity Instrument are not, significantly related to psychological processes central to the stuttering experience. Depression and, personality characteristics do not meaningfully account for stuttering. EDUCATIONAL OBJECTIVES The reader will be able to: (a) differentiate forms of anxiety that are likely to be associated with stuttering (b) understand the importance of determining features of stuttering that go beyond the obvious, surface characteristics of stuttering frequency, and (c) discuss the important clinical and theoretical implications for understanding the degree of psychological dysfunction that is likely to be characteristic of those who stutter.

Listener response to stuttering modification techniques

In two investigations, nonprofessional listeners used a 25-item bi-polar adjective scale to evaluate an adult male speaker who stuttered. In investigation one, 24 listeners evaluated the speaker during a Stuttering Only and a Stuttering + Cancellation condition. In investigation two, 50 listeners evaluated the speaker in a Stuttering Only and a Stuttering + Pullout condition. Listeners in the first investigation did not assign significantly different ratings to the Stuttering Only and Stuttering + Cancellation conditions. In the second investigation listeners rated the Stuttering Only condition more positively than the Stuttering + Pullout condition (p < 0.05). Analysis of listener response to four open-ended questions indicated significantly more positive reaction to the Stuttering Only condition than either of the Stuttering + Modification conditions. Finally, listeners rated the speaker using the cancellation and pullout techniques as being significantly more handicapped than when he was stuttering only. The findings provided preliminary evidence indicating that everyday listeners may react less favorably to an adult male speaker who is modifying his stuttered speech than when this same speaker is simply stuttering.

Personality dysfunction in adults who stutter: Another look

PURPOSE Given reports of the frequent occurrence of personality disorders (PD) among individuals who stutter, this investigation was designed to determine the presence of personality disorders (PD) for individuals seeking treatment for stuttering, using a different self-report measure. METHOD The sample included 50 adults who were undergoing treatment for stuttering. The participants also completed a self-report measure (Assessment of the DSM-IV Personality Disorders, ADP-IV) that is known to have good differential validity in the assessment of personality disorders as well as good convergent validity with a structured interview administered by a skilled mental health professional. RESULTS Four participants met threshold values for one personality disorder (PD) and one participant met criteria for two personality disorders. The remaining 45 participants (90%) did not meet criteria for a PD. CONCLUSION Rates of observed PDs in this sample approximated rates that have been observed in general community samples using structured clinical interviews and trained interviewers. Related reports which have claimed high levels of personality disorders among adults who stutter appear to be inflated by the use of self-report devices that overestimate the occurrence and co-morbidity of these conditions. Implications for the treatment of adults who stutter are discussed. EDUCATIONAL OBJECTIVES The reader will be able to (a) summarize two basic perspectives of how individuals who stutter are influenced by the possibility of personality dysfunction (b) describe the factors that influence the detection of personality dysfunction using self-report procedures, discuss the important (c) theoretical and (d) clinical implications of accurately identifying personality dysfunction for adults who stutter.