Academic journal article Health and Social Work

Counseling, Support, and Advocacy for Clients Who Stutter

Academic journal article Health and Social Work

Counseling, Support, and Advocacy for Clients Who Stutter

Article excerpt

For most people, speaking is as natural as breathing. However, 1 percent of adults and 3 percent of children in the world who stutter cannot take fluency of speech for granted (Bloodstein, 1993). Fluency refers to the effortless flow, rate, rhythm, and patterns of stress and intonation in speech production. Fluency disorders may be caused by cerebral accidents, Tourette's syndrome, and other medical conditions, but the most common fluency disorder is stuttering (Cooper, 1997).

Stuttering is characterized by disrupted synchrony of respiration, phonation, and articulation and is usually accompanied by excessive muscular tension (Hulit, 1996). On average, three times as many males as females stutter (Bloodstein, 1993). The listener is apt to perceive a speech disfluency as stuttering when the speaker repeats a sound or syllable, prolongs a sound, makes an unusual pause between sounds or syllables of a word, or repeats a monosyllable word. Perception is the operative word; a determination of overt stuttering is therefore based on the listener's interpretation of the sounds, words, or phrases that are vocalized (Conture, 1990).

Many people who stutter consult speech-language pathologists (SLPs) for assistance because these professionals are experts in the anatomy, physiology, and motor systems of the speech mechanism and can provide education and behavior modification to achieve greater control over speech (Cooper, 1997). Because stuttering is commonly characterized by emotional, behavioral, and cognitive components that may inordinately affect interpersonal and social relationships of the speaker, many SLPs include counseling in the treatment plan. Yet, many SLPs are reluctant to make referrals to social workers or counselors because of a belief that mental health professionals are generally uninformed about disfluency (Luterman, 1996).

Nevertheless, an interdisciplinary approach can help people who stutter achieve a better quality of life and improved chances of maintaining acquired skills in speech management. This article informs social workers about the physical, psychological, and social causal factors and implications of stuttering to enable them to establish effective partnerships with SLPs and, most important, effective therapeutic relationships with clients who stutter.


Because no definitive cause for stuttering has been proven, and there is controversy about factors involved in its development, studies or authors who claim to have discovered its etiology should be viewed with skepticism. Theories that consider parents at least partially to blame or list individual psychological factors that contribute to stuttering are no longer considered accurate (Hulit & Wirtz, 1994). The predisposition to stutter appears to be genetic, but this is not viewed as the only cause (Logan, 1999). Although stuttering is believed to have some connection with neurological coordination or timing of the speech mechanisms, it is not an emotional problem or nervous disorder (National Stuttering Association [NSA], 1999). Yet, principles of learning and emotional reactions to stuttering contribute to its development and maintenance (Logan). In other words, although the block is neurophysiologically determined, the negative emotional response is learned.

These negative reactions result in secondary symptoms as the individual engages in behaviors that temporarily make the stuttering seem less severe, which include movements to get the sound or word started (for example, closing the eyes, tongue protrusions, clenching of fists, gasping, emptying the lungs or stopping breathing, or interjecting sounds or words) (Bloodstein, 1993). Word substitution is a common practice to avoid words or phrases that may be viewed as difficult to pronounce (Jezer, 1997). These behaviors are learned by association with success in overcoming a block, that is, when a person's speech mechanism ceases "to move forward to the next sound position" (Conture, 2001, p. …

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