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Stammering case study - teenage boy
This case study outlines a successful outcome
for stammering modification using hypnotherapy
alongside an eclectic mix of cognitive behavioural
approaches, within an evidence-based methodology.
A programme of 4 sessions was held. Fluency improvements were noted after
the initial session, and have continued.
Furthermore, the client’s self-confidence
and wellbeing have improved as well as his
motivation to continue to speak more fluently.
This is what he said about the programme.
“I found the sessions with Caroline
very helpful because she gave me a way not
to stammer by using a special breathing technique.
The technique is very simple to use –
much easier to remember than the many different
techniques I was taught by speech and language
therapists – but a lot of the time
I forget to use it, so I decided to put up
Post-It notes around the house (on walls
and doors, etc.) to remind me. The hypnotherapy
has greatly improved my confidence –
I have been speaking out a lot more with
teachers at school – and it was very
relaxing to be hypnotised.”
The client
The client is a teenager, in 5th year of school. He has been stammering since
he was about 5. He had tried various approaches
including speech therapy, but without success.
Stammering was not confined to particular
situations or people, but occurred at school,
at home, with family and friends as well
as strangers.
The programme
The programme consists of 4 sessions each
1 to 1½ hours.
The fluency protocol is based on Azrin and
Nunn’s groundbreaking work in the 1970s.
This approach continues to provide excellent
results and was further endorsed by Miltenberger
et al in 1998. It is a based on a range of cognitive
and behavioural activities. I take an evidence-based
eclectic approach and aim to develop skills
of long-term value to my clients. The programme
includes hypnosis for its enhancing effect
on other therapy approaches and anxiety reduction.
Whether as cause or effect, anxiety is involved
in stammering.
Gaining positive support from a member of
the family and friends – “buddies”
– is essential. Their role is to encourage
practice of the techniques, spot the onset
of stammering, identify stammering-prone
situations, and compliment success. I invited
family members to get involved in the first
session so they could experience and understand
what goes on in a session and I outlined
the role of the “buddy”.
In the first session, I briefly demonstrated
hypnotic relaxation and then outlined the
breathing technique. The breathing technique
physically competes with stammering. When
it is used, stammering is not possible. With
practice, this competing behaviour becomes
everyday and normal.
With the basics established and everyone
feeling relaxed, my client and his family
talked about how, when and where he stammers,
and identified particular problem situations
– including speaking on the phone,
saying his own name, and difficult consonants
(such as b,p, g, k). The final element included
suggestion hypnotherapy, incorporating key
details about the breathing protocol. Homework
was to recruit a further buddy and start
practising.
Learning to relax deeply, both mentally and
physically is an important part of the programme.
Muscular tightness in the chest, shoulders
and throat conspire to inhibit fluent speech,
so being able to relax at the first signs
of tightness, or in preparation for a stammering-prone
situation, reduces the risk of blocking.
Further elements of the protocol were outlined,
and these formed the homework assignment.
In hypnosis, my client rehearsed a stammering-prone
situation, and doing it for real was further
homework.
Self-hypnosis, assertiveness training and
telephone skills are integral to the programme.
Self-hypnosis is simple to learn and easy
to do. Like all skills, it gets better with
practice. Self-hypnosis encourages the development
of self-reliance and confidence. It reduces
the risk of anticipatory anxiety and develops
greater awareness of how, when and why stammering
occurs. It can be used to relax and regain
self-control, for example before doing something
difficult or stressful, and to reinforce
positive ideas of coping and success. It
encourages the transfer of therapy goals
into the real world. Hypnosis is a very pleasant
experience, and this is very motivating.
Assertiveness is a key life skill but it
is harder to make your point when you struggle
to speak. It can seem easier to say nothing.
Assertiveness training empowers you to take
the time you need to say the things you need
to say. I teach initially a structured approach
to getting a point across. Getting thoughts
arranged before speaking generates a feeling
of control. With practice, skills and self-confidence
increase. Hypnotic suggestions that there
is plenty of time and that people are interested,
support assertive behaviour. At this stage
in the programme, when my client was feeling
assertive and self-confident, telephone techniques
were introduced. The goal was to find a way
to minimise the risk of blocking and getting a two-way
conversation going. Homework assignment was
to make a phone call.
The key elements of the programme remain
consistent, supplemented or rearranged so
that the client is achieving his or her goals.
Together they form a coherent and successful
approach which allows clients to gain control
over their speech and improve fluency.
Conclusion
This is what the client’s mother said:
In the first session, my son was given a
breathing technique that immediately helped
with his fluency. He doesn’t yet remember
to use it all the time, but after more than
10 years of stammering we don’t expect
miracles overnight. However, with continued
practice there is no reason why his speech
and breathing should not become automatically
synchronised. And now, when he does become
stuck, he knows how to unblock quickly. After
four sessions of hypnotherapy, I can see
that his anxiety levels are much lower and
that he speaks more freely on the telephone
and with his friends. I think the variety
of approaches used by Caroline means that
problems are addressed on many different
levels".
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