By Patricia M. Zebrowski, Ph.D.
University of Iowa

From the Stuttering Foundation's 2008 summer newsletter

A number of years ago, I became interested in the study of 'Positive Psychology' (Seligman, 2002 ) as it may be applied to helping children who stutter and their parents uncover and appreciate the strengths they bring to the therapy experience, strengths that likely play a major role in treatment outcome.

As Wampold and his colleagues (1997) in the areas of psychotherapy and counseling psychology have long argued, I have come to believe that the attributes of both the client and the clinician that matter most in therapy success, and while fluency and stuttering management techniques are essential to any kind of speech change, they make a relatively small contribution to the overall experience. As an example, consider the current clinical and research interest in child temperament and how it may relate to either stuttering development or recovery, or to treatment success. Our focus in considering temperament is frequently on how it may be causal or related to the perpetuation of stuttering and an obstacle to therapy. This is certainly a valid assumption, and clinical experience suggests that it can be the case. However, looking for 'what's wrong' with the child with regard to temperament may prevent us from considering how temperament may also represent a 'strength' for the child, something that we should point out, nurture, and discuss with the parents as a way to highlight for them 'what's right' with the child.

Regardless of their similarities or differences, how can the temperament and personality of a child who stutters represent a 'signature strength' (Seligman, 2002), and thus contribute to a positive outcome in therapy? For example, preliminary research has shown that children who stutter who exhibit the temperamental substrate of rhythmicity, or temporal regularity in eating, sleeping, and elimination, may be more likely to benefit from the practice effects associated with picture naming (which might be associated with the practice effect of therapy) than do children with less rhythmic biological cycles (Arnold, Conture & Walden, 2004). As such, there may be increased likelihood of transfer and maintenance of speech modification skills presented in therapy, regardless of what those strategies might be.

As another example, consider the child who experiences a strong degree of reactivity and subsequent negative emotional response to either his stuttering, or the reaction of others to his stuttered speech. If the child has developed the ability to regulate his reactions to his own behavior (stuttering) or environmental reaction (e.g., routinely shift his attention onto more pleasant, positive or facilitating stimuli, events or people), he may fail to develop habituated avoidant speech or interaction strategies that have long been thought to characterize, and perhaps contribute to, chronic stuttering. In such cases, the child can be described as resilient, in that his temperament and related adaptive skills facilitate the ability to 'bounce back' or take relatively negative stuttering related experiences in stride. Further, a child whose levels of reactivity, emotional response, and ability to self-regulate contribute to a more dominant, extraverted and sociable personality might be inclined to readily and positively approach various social and communication situations, including therapy (as opposed to reluctantly and negatively approaching same).

In addition, such a child might display a relatively high degree of attentional focus and risk-taking while participating in therapy, and may actively seek out novel experiences while also being more apt to take risks in both social and speaking situations. The willingness and ability to take risks has long been considered a trait important to progress across all types of therapies (Yalom, 2002). It is my hope that future research will focus on how temperament and other client and clinician attributes interact with the techniques we teach to influence the outcome of stuttering therapy.

References:
Arnold, H., Conture, E., & Walden, T. (2004). Relation of temperamental characteristics to picture-naming practice effects in children who stutter: Preliminary findings. Poster presented at the annual meeting of the American Speech-Language-Hearing Association, Philadelphia, PA.
Seligman, M (2002). Authentic happiness: Using the new positive psychology to realize your potential for lasting fulfillment. Free Press.
Wampold, B.E., Mondin, G.W., Moody M., Stich, F., Benson, K. & Ahn, H. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, 'all must have prizes.' Psychological Bulletin, 122, 203-215.
Yalom, I. (2002). The Gift of Therapy. New York: Perennial; Harper Collins.