Theoretical/clinical model of stuttering
There are many variables involved in determining and maintaining stuttering. Here, we will examine the psychological and environmental variables that play an important role in rehabilitation.
Our model believes that dis-fluent behavior is learned and maintained by psychological/environmental variables: if a child, for any reason, starts to stutter, the particular attention of the parents regarding this or the teasing from the child’s peers, determine an increase in “stuttering behavior” and a strong sense of personal debasement and failure; these negative feelings further aggravate speech itself. In the stuttering subject’s attempts to make the speech fluent, overcoming blocks and hesitations, speech becomes explosive, impetuous, as if by force the subject had to overcome all sorts of resistance.
At the same time, the psychological experience is aggravated, which causes the subject to experience a sense of continuous frustration, with manifestations of quick anger and aggression, or complete introversion and/or submission due to the profound sense of inadequacy, shame and embarrassment.
The feelings of personal failure, impotence and little personal value, in the youngest subjects lead to early abandonment of the study, low expectations regarding the need for self-fulfillment and a widespread avoidance behavior of all social and interpersonal situations for fear of stuttering and then being laughed at.
In this way, a true phobic-type cognitive organisation develops.
Phobic avoidance in stuttering
Ordering a coffee, buying a newspaper, asking for information or participating at school or in social contexts is practically impossible. The subjects, in order to avoid others noticing their difficulty, along with the consequent feeling of anxiety, frustration and shame, prefer not to expose themselves; they renounce, avoid and abandon any confrontation situation.
This widespread escape behavior reinforces the image of a different, inferior person and increases even more the ineffectiveness in controlling speech, emotions and, consequently, social relations, which are less and less sought after, also bringing the further lowering of an already scarce self-esteem and sense of personal value.
Rehabilitation path
The presentation of the stuttering model described so far clearly shows that the core of the problem is phobic organisation, i.e. the fear of speaking in public and talking to others. This fear leads to the avoidance of such situations, consequently contributing to maintaining the phobic problem; thus the vicious circle of self-maintenance is completed and unfortunately destined to last over time.
The total blockage of exploration means that it is impossible to experiment with different, alternative behaviors to those involving shutting themselves off, therefore subjects will not be able to learn to invalidate their catastrophic convictions.
This happens only through exposure to anxiogenic stimulus enabling irrational beliefs to be invalidated and more appropriate and adaptive behaviors to be adopted. For this reason, it is necessary that the subject learns to accept negative judgment from others, criticism, even derision and being the object of mockery, however all the while with the awareness that a person’s value is something else that can never be linked to a single element of life or a single attitude or behavior. Value is given by our history, our affections, our deepest beliefs, our set of ethical and moral values and many other things; it cannot be questioned by a locutorial difficulty.
Working on cognitive organisation and self-esteem requires specialist intervention with an experienced psychotherapist who must be taken seriously. This is a very important step in the rehabilitation model we are inspired by.
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