Content uploaded by Walter Manning
Author content
All content in this area was uploaded by Walter Manning on Oct 10, 2017
Content may be subject to copyright.
Journal of Fluency Disorders 30 (2005) 1–22
A phenomenological understanding of successful
stuttering management
Laura Plexicoa,∗, Walter H. Manninga, Anthony DiLollob
aThe University of Memphis, Memphis Speech and Hearing Center,
807 Jefferson Avenue, Memphis, TN 38105, USA
bWichita State University, USA
Received 22 January 2004; received in revised form 2 November 2004; accepted 17 December 2004
Abstract
The purpose of this investigation was to understand, from the perspective of the speaker, how
seven adults have been able to successfully manage their stuttering. Individual experiences were
obtained across the three temporal stages (past, transitional, and current). Recurring themes were
identified across participants in order to develop an essential structure of the phenomena at each
stage. The ability to make the transition from unsuccessful to successful management of stuttering
was associated with six recurring themes of: (1) support, (2) successful therapy, (3) self therapy and
behavioral change, (4) cognitive change, (5) utilization of personal experience, and (6) high levels
of motivation/determination. Six recurring themes associated with past experiences, when stuttering
was unsuccessfully managed, included: (1) gradual awareness, (2) negative reactions of listeners,
(3) negative emotions, (4) restrictive lifestyle, (5) avoidance, and (6) inadequate therapy. The five
recurring themes identified for the current situation where stuttering continues to be successfully
managed were: (1) continued management, (2) self acceptance and fear reduction, (3) unrestricted
interactions, (4) sense of freedom, (5) and optimism.
Educational objectives: The reader will be able to: (1) describe, from the prospective of a select
group of adults who stutter, the recurring themes associated with both unsuccessful and successful
management of stuttering, (2) explain the recurring themes associated with how this group of seven
adults achieved successful management of their stuttering, and (3) discuss the basic rationale and
procedures associated with phenomenological analysis.
© 2005 Elsevier Inc. All rights reserved.
Keywords: Successful management; Essential structure; Stuttering; Adults
∗Corresponding author. Tel.: +1 901 678 5800.
E-mail addresses: lewerner@memphis.edu (L. Plexico), wmanning@memphis.edu (W.H. Manning).
0094-730X/$ – see front matter © 2005 Elsevier Inc. All rights reserved.
doi:10.1016/j.jfludis.2004.12.001
2L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22
1. Introduction
Clinical research on stuttering has often focused on determining severity, predicting
chronicity, documenting treatment outcomes, and preventing relapse following treatment.
The process of successful management of stuttering (both with and without therapeutic in-
tervention) has received relatively little attention. We view management as a process and for
the present study we chose to use, where possible, the term successful management (of stut-
tering)ratherthantheterm“recovery”.We did this for three reasons. First, the term recovery
suggests the appropriateness of a medical model that conceptualizes stuttering as a disease
and tends to pathologize the individual (Monk, 1997;Raskin & Lewandowski, 2000). Sec-
ondly, successful management is more descriptive than recovery since many people who
achieve high levels of fluency report that they do so by continuing to attend to a variety
of speech-related events, including cognitive and attitudinal factors rather than completely
ceasing stuttering. Finally, rather than applying the criteria based solely on the presence or
absence of stuttering behavior as implied by the term recovery, we were interested in the
speakers’ perspectives of their ability to successfully manage their stuttering.
The earliest investigations of stuttering management and recovery used structured sur-
veys or interviews to identify factors associated with success. For example, Wingate (1964)
used a structured survey to obtain information from 50 “recovered” persons who stut-
tered. Wingate’s findings identified several factors related to recovery, with changes in atti-
tude (self-appraisal and acceptance of self) and speech practice being the most prominent.
Wingate suggested that both these factors may be related to “motivation” by the participant
and reported that a number of participants related successful changes in attitude to “the sup-
port of another person” or to “experiences which encouraged better self-appraisal” (p. 317).
Sheehan and Martyn (1966, 1970) also used structured surveys to gather information on
the recovery process. Their findings were similar to those reported by Wingate (1964), with
increasing self-esteem, strengthening of approach behavior, and role acceptance identified
as primary factors attributed to recovery.
Shearer and Williams (1965) used a structured interview to obtain information from 58
persons who reported that they had recovered from stuttering. They identified a number
of factors that these individuals indicated “had helped or would help in the recovery from
stuttering”(p.289).ThefactorsidentifiedbyShearerandWilliamsparalleledthefindingsof
Wingate(1964)andSheehanandMartyn(1966,1970),withgreaterself-confidence,greater
awareness of the problem, and improved relaxation reported as important contributions to
recovery. Inaddition,ShearerandWilliams reportedthatslowingtherateofspeech, thinking
before speaking, and speaking more deliberately were also helpful.
Quarrington (1977) provided anecdotal comments from 27 adults who described their
recovery from stuttering without treatment. Although the nature of the interviews was not
described, participants indicated that the recovery process was gradual and ranged from 1 to
5 years. For the majority of the participants, recovery was reportedly associated with greater
self-worthandlessenedfeelings ofhelplessnessabout speech.Participants alsodescribedthe
use of specific behavioral techniques that enabled them to change their pattern of speaking.
Recognition of the individual nature of both stuttering and its management resulted in a
number of recent qualitative studies with persons who stutter. Corcoran and Stewart (1998)
used a qualitative research paradigm and a narrative approach to examine the experience
L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22 3
of stuttering for eight adults who were enrolled in a fluency program. Their participants
included five men and three women who stuttered and ranged in age from 25 to 50 years.
Corcoran and Stewart elicited narratives using a semi-structured long interview technique
with open-ended questions and follow-up prompts. The primary theme that they found for
these participants was suffering. Corcoran and Stewart suggested that suffering resulted
from experiences such as blocking, humiliation, dread, and isolation, which resulted in
feelings of helplessness, shame, fear and avoidance.
To understand the communicative experiences and coping strategies of adults who
stutter, Crichton-Smith (2002) analyzed the narratives of 14 adults aged 26–86 (average
age= 56). Narratives were elicited using semi-structured, face-to-face interviews. The ac-
counts elicited by Crichton-Smith indicated that the participants’ lives were limited in
terms of employment, education, and self-esteem by either personally or socially imposed
constraints. There were frequent examples of avoidance being used as a coping strategy.
Strategies that were learned as a result of formal intervention (e.g., opportunity to talk
about stuttering, fluency enhancing and stuttering modification techniques) were consid-
ered by the participants to be better than those strategies that were intuitive on the part of the
speaker(e.g., forcingout thespeechor avoiding).Crichton-Smith found,as didCorcoranand
Stewart (1998), that the key elements of the stuttering experience were suffering, helpless-
ness, shame, and stigma. However, Crichton-Smith noted that the 14 individuals she studied
experienced these elements to varying degrees at different stages of their lives.
Finn(1996) employeda structured, open-ended interviewtechnique that examined unas-
sisted recovery from stuttering in 14 adults. Participants were interviewed and asked about
their past stuttering, past treatment, and factors that contributed to their recovery. Finn used
content analysis to analyze the participants’ responses and developed nine categories for
coding the responses based on previous research concerning spontaneous recovery from
stuttering (e.g., motivation, attitude change, modification in speech behavior, practice, en-
vironmental change, and maturation). Finn found that speaking with a modified speech
pattern (79%), motivation (43%), environmental changes (29%), and changes in attitude
toward self (29%) and the speech problem (14%) were the primary factors described by the
participants as being important to recovery.
Finally, Anderson and Felsenfeld (2003) employed thematic analysis to understand the
nature of later recovery from stuttering. Interestingly, this study was being conducted at
the same time as the present study and in many ways the two investigations parallel each
other. Anderson and Felsenfelds’ six adult participants ranged in age from 18 to 55 and
reported that they stuttered in the past but no longer did. Five of the six participants in-
dicated that they previously had received formal treatment with three attributing at least
part of their recovery to that experience. Using a semi-structured interview, Anderson and
Felsenfeld interviewed the participants, asking them to describe the factors they felt were
responsible for their recovery. None of the participants were currently receiving treatment
and none had participated in a self-help or support group. Analysis of 500-word sponta-
neous speech samples indicated that none of the speakers had disfluency rates that exceeded
2.0%, and core stuttering behaviors (sound-syllable repetitions, sound prolongations, and
broken words/blocks) averaged 0.6%. The mean naturalness rating (Martin, Haroldson, &
Triden, 1984) for all participants was 1.33 (no rating greater than 2 on the 9-point scale),
indicating that all speakers were rated as highly natural by three judges. When recalling
4L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22
past stuttering and its impact, common themes were disapproval, shame, low self-esteem,
vulnerability, fear and a restrictive life style. The thematic categories that indicated the
majority of attributions associated with successful management were increased confidence,
increased motivation (expressed as a desire to make speech changes) and specific speech
changes.
Althoughthese studiesprovideimportantinformationon potentialfactorsassociated with
recovery, the methodsusedtocollect the data limited the participant’sresponses to questions
that were pre-determined by the researchers to be related to recovery. Consequently, this
allowed the participants to provide only thin descriptions of their experiences, descriptions
that may have been focused only on the problem of stuttering and removed from the context
of each individual’s unique journey from stuttering to successful management.
The present study uses a phenomenological approach to focus on a group of individ-
uals who have been able to maintain successful management of their stuttering, with the
goal of describing in detail the underlying factors that they considered relevant to this phe-
nomenon. The phenomenological approach to research focuses on “the meaning of the lived
experiences for several individuals about a concept or the phenomenon” (Cresswell, 1998,
p. 51). From the descriptions of the phenomenon provided by the individuals, general or
universal meanings are derived, allowing the researcher to develop an essential structure1
of the phenomenon in question (Cresswell, 1998; Moustakas, 1994). We chose to use a
phenomenological approach to investigate the successful management of stuttering for a
number of reasons. Firstly, the phenomenon of successful management of stuttering ap-
pears to be highly complex, relating to a myriad of personal and experiential factors that
make prediction of important factors difficult. Secondly, a qualitative approach to study-
ing this phenomenon locates the data in the context of the unique lived experience of the
participants and gives value to the specific knowledge of the individuals experiencing the
phenomenon—they tell us what factors were important in their journey as they moved from
unsuccessful to successful management of stuttering.
This philosophical position is also consistent with suggestions in the literature for the
need to focus on individual, rather than group, data as a means for understanding recovery
and assessing the effects of treatment. For example, Starkweather (1999) and Quesal (1989)
suggested that a primary reason for our lack of success in understanding and combating
relapse following initially successful therapy for stuttering is the tendency to study the
generalities or commonalities of stuttering via group studies rather than placing greater
emphasis on the individual. In addition, Quesal argued that it is clear that any assessment
of stuttering should take into account the perspective of the person who stutters, especially
since this perspective is a critical part of the treatment process.
The purpose of this investigation is to explore, from the speakers’ perspectives, themes
that help to explain the ability of selected speakers to successfully manage their stuttering.
Theprimaryquestiontobeinvestigatedin this study was:Fromtheperspectiveof the person
who stutters, what is the essential structure of the process that leads to successful manage-
ment of stuttering? In order to place the process of successful management into perspective,
1Bogdan and Biklen (1998) and Moustakas (1994) suggested that the essential structure of a phenomenon may
be derived when the phenomenon is observed over time and across several different situations. Cresswell (1998,
p. 55) described it as “a single unifying meaning” of the experience.
L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22 5
a secondary question was posed: From the perspective of the person who stutters, what was
the experience of stuttering both before and following successful management?
2. Method
The methodology used in this study was derived from the framework of phenomenology
(Cresswell, 1998; Moustakas, 1994). The fundamental principle of this approach is that per-
sons who have experienced a phenomenon, and can provide comprehensive descriptions of
thatphenomenon,aremost suitable for describing the essential structure of the phenomenon
(Moustakas, 1994). One of the underlying tenets of this philosophy is that, although the
meaning of experience creates highly individualized “reality,” the essential structure of a
phenomenonmay be derivedwhenthephenomenonis observed overtimeand across several
differentsituations (Bogdan&Biklen, 1998;Moustakas, 1994). Phenomenologicalresearch
strives to answer two basic questions: (1) What is the essential and invariant structure of
the phenomenon being studied and (2) How does it present itself (Valle & King, 1978).
2.1. Participants
Both general and specific criteria were used to select the participants. In general, the par-
ticipantsneeded to beable to (a) providerich descriptions ofthe phenomenon, (b)adequately
communicate their experiences with the phenomenon, and (c) be willing to fully share their
experiences about the phenomenon being explored. Specifically, the participants needed to
(a) be a person who stuttered past childhood, (b) indicate that they are currently successfully
managing their stuttering, (c) be an adult greater than 18 years of age and (d) view the
successful management of their stuttering as something that developed over the course
of time.
The participants in this study included six adult males and one adult female, each
with a history of stuttering well into adulthood. The participants had a wide range of
treatment histories, had lived throughout the country, and ranged from 38 to 59 years
of age. All of the participants had previously received therapy for their stuttering. The
Stuttering Severity Instrument (SSI-3) (Riley, 1994) was administered by the first author
immediately following the interview. None of the participants currently had an SSI-3
score greater than “very mild” (range 2–12), and all of the participants rated themselves as
experiencing little to no handicap associated with their stuttering, based on a 9-point equal-
appearing interval scale (1= no handicap; 9 = severely handicapped; average score: 1.92,
range: 1–3).
Theparticipants were uniqueina number ofways.All were professionalsandheld at least
one graduate degree. Five of the seven participants were speech-language pathologists who
reportedthat they wereactivelyinvolvedinprovidingservices to peoplewhostutter.Thetwo
individuals who were not speech language pathologists participated extensively in self-help
organizations for people who stutter. Given these characteristics and their ability to manage
their stuttering, these individuals certainly were not likely to be representative of most
adultswho stutter. Nevertheless,it was believedthat these highly successful individuals who
routinely participated in demanding speaking tasks (e.g., lecturing, presenting at national
6L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22
and international conferences) may have employed some unique strategies and insights that
would be useful to identify.
2.2. Description of individual participants
Participant 01, a male in his late 50s, is currently a speech-language pathologist who
specializes in the field of stuttering. Stuttering modification, fluency shaping, desensiti-
zation, voluntary stuttering, behavior modification, and psychotherapy were some of the
different types of therapy and techniques P01 has experienced. P01 reports that he is able
to successfully manage his stuttering and has an SSI-3 score of 5 (very mild) and self-rated
his degree of handicap asa2(verymild).
Participant 02, a male in his early 50s, is a health care professional who is actively
involved in self-help and support groups for stuttering. Stuttering modification, desensitiza-
tion, behavior modification, and psychotherapy were some of the different types of therapy
and techniques P02 has had or used. Currently P02 reports that he is able to successfully
manage his stuttering and has an SSI-3 score of 7 (very mild) and self-rated his degree of
handicap asa1(verymild).
Participant 03, a male in his late 40s, is currently a speech-language pathologist who spe-
cializes in the field of stuttering. Stuttering modification, fluency shaping, desensitization,
voluntary stuttering, behavior modification, and psychotherapy were some of the different
types of therapy and techniques P03 had experienced. Currently P03 reports that he is able
to successfully manage his stuttering and has an SSI-3 score of 7 (very mild) and self-rated
his degree of handicap as a 2.5 (mild).
Participant 04, a female in her late 30s, is currently a speech-language pathologist who
specializes in the field of stuttering. Stuttering modification, fluency shaping, desensitiza-
tion, voluntary stuttering, and psychotherapy were some of the different types of therapy
and techniques P04 has experienced. Currently P04 reports that she is able to successfully
manage her stuttering and has an SSI-3 score of 5 (very mild) and self-rated her degree of
handicap asa1(verymild).
Participant05, amale in his mid 50s, is currently a speech-language pathologist who spe-
cializes in the field of stuttering. Stuttering modification, fluency shaping, desensitization,
voluntary stuttering, and operant conditioning were some of the different types of therapy
and techniques P05 has experienced. Currently P05 reports that he is able to successfully
manage his stuttering and has an SSI-3 score of 12 (very mild) and self-rated his degree of
handicap asa2(verymild).
Participant 06, a male in his late 40s, is currently a social worker who is actively involved
in a national support group. Stuttering modification, desensitization, and behavior modi-
fication were some of the different types of therapy and techniques P02 has experienced.
Currently P02 reports that he is able to successfully manage his stuttering and has an SSI-3
score of 8 (very mild) and self-rated his degree of handicap asa2(verymild).
Participant07, amale in his mid 50s, is currently a speech-language pathologist who spe-
cializes in the field of stuttering. Stuttering modification, fluency shaping, desensitization,
and voluntary stuttering were some of the different types of therapy and techniques P07 has
experienced. Currently P07 reports that he is able to successfully manage his stuttering and
has an SSI-3 score of 5 (very mild) and self-rated his degree of handicap as a 3 (mild).
L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22 7
Table 1
The open-ended questions and four planned prompt questions asked of each participant during the interview
Open-ended questions
1. Chronologically, how has stuttering affected the way you live your life?
a. as a child in primary school
b. while in high school
c. while in university or college
d. after completing your education
e. in the past 10 years
2. How has stuttering affected the important relationships in your life, for example with the following?
a. family
b. friends
c. teachers
d. members of the opposite sex
e. spouse
f. children
g. employers
h. co-workers
Planned prompts
1. How did stuttering affect the way you view yourself and world in the past and now in the present?
2. Does stuttering affect the way you look at the future?
3. What role did speech therapy play in your experience of stuttering?
4. Has stuttering had any positive effects on the way you live your life?
2.3. Procedure
Each of the seven participants took part in one interview with no pre-established time
frame. All of the interviews were conducted by the first investigator in a quiet room. A semi-
structured interview similar to that used by Corcoran and Stewart (1998) was employed.
Accordingly, the interviewer used two “open-ended” questions (Spradley, 1979) and four
plannedprompts (seeTable1).Theseopen-ended questionswereintended toretrievetheper-
sonal experiences of the participant without imposing any biases from the interviewer. The
open-ended questions were designed to elicit the participants’ stories of how the experience
of stuttering affected them at different stages of their lives and in their various relationships.
The four planned prompts focused on the more specific aspects of the participants’
experience with stuttering and the process of change. The planned prompts were placed at
the end of the interview and were not used unless a topic of interest associated with these
questions did not emerge. These planned prompts addressed the areas of future plans, the
transformingeffects of stuttering,theeffects ofspeechtherapy and the possibilityofchanges
in self-interpretation over time. Finally, unscheduled prompts were also used during the in-
terview when further elaboration or clarification of what the client was relating was needed.
Examples of unplanned prompts include, “tell me more about that” or “what do you mean?”
2.4. Credibility
Credibility was addressed using a 4-step process based on the procedures used by
Corcoran and Stewart (1998) and outlined by Cresswell (1998) and Lincoln and Guba
8L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22
(1985). The four steps used to check credibility were:
1. All interviews were tape-recorded and transcribed verbatim.
2. The investigators addressed their personal and professional biases regarding stuttering
andwhat findings they might expect from the study before analyzing the interviews. This
was done to help the investigators to fully understand the experiences of the participants
without imposing any a priori hypotheses on their experience (Riemen, 1986). Although
the three investigators differed in their knowledge and experiences regarding stuttering,
they attempted to identify and suspend their personal biases and preconceptions at the
outset of the investigation. As Corcoran and Stewart (1998) indicated, different inves-
tigator backgrounds reduce the likelihood of the investigators sharing biases regarding
the experience of stuttering. The first investigator in this study, a fluent speaker with no
history of stuttering, had a bachelor’s degree in communication sciences and disorders,
and was a student enrolled in the second year of a master’s degree program. The second
investigator was a board recognized specialist in fluency disorders (BRS-FD) with a
Ph.D. in speech-language pathology and 34 years of experience in the area of fluency
disorders. He stuttered through early adulthood and is now a fluent speaker. The third
investigator, also a fluent speaker with no history of stuttering, was a clinically certified
speech-languagepathologist with a Ph.D. and 7 years of experience in the area of fluency
disorders.
3. Investigator triangulation was used to view the data from more than one point of view.
The investigators analyzed the transcripts separately to identify key utterances and de-
rive their own themes. Once the individual analyses were completed the investigators
compared their findings and came to a consensus.
4. The process of member checking was used to ensure valid interpretation of statements in
the transcripts. Member checking was conducted by mailing each participant the themes
and categories derived from the analysis of the transcribed interview. Each participant
was asked to review and comment on the appropriateness of the themes and categories
to make sure that the themes derived from the narratives were consistent with that
individual’s reported experience.
2.5. Analysis
Individual experiences from the transcribed interviews were extracted from the narra-
tive transcriptions and became the data for analysis. As individual experiences were being
extracted from the transcripts, it became evident that all of the relevant themes could not be
presented in short statement form. Many themes were presented in the form of a short story.
In those instances, a brief summary statement about the participant’s overall experience was
generated to represent the overall story. After all of the individual experiences had been
identified, repetitive and similar statements were eliminated.
The transcripts and subsequent data categories were analyzed inductively based on the
constant comparative method proposed by Bogdan and Biklen (1998). Analysis of each
transcript required the investigators to agree on the following categories.
1. Individual experiences: Two investigators separately performed a line-by-line analysis
of each transcript. During this analysis, the investigators read the transcripts a minimum
L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22 9
of two times and noted the participants’ experiences, events, and interpretations of their
lives. These could take the form of words, phrases, sentences, and paragraphs. These
segments could represent more than one experience and experiences could overlap each
other. These segments were highlighted within the text and labeled in the margins of
the transcript. Next, the investigators again reviewed each of the narratives, this time
together, for the purpose of coming to a consensus about each of the seven participants’
individual experiences.
2. Temporal stages: As the investigators identified the individual experiences described
by each participant, they also assigned codes indicating one of three temporal stages.
Individual experiences were identified “Past” if the participant was describing events
from the past, when stuttering was essentially unsuccessfully managed, “Current” if the
participant was describing his or her current situation, when stuttering is successfully
managed or “Transition” if the participant was describing a period of transition from his
or her past to his or her current life situation, the process of moving from unsuccessful
management to successful management of stuttering.
3. Recurring themes: Together, the investigators considered the extensive list of individual
experiencesextracted from the transcripts of alltheparticipants. Investigatorsthen deter-
mined how the individual experiences could be combined into broader recurring themes
across all seven participants (e.g., negative emotions: embarrassment, fear, shame). The
recurring themes were classified according to the open-ended questions and planned
prompt topics the participants were asked to comment on during the interview (e.g.,
family, school, work). The temporal stage, open-ended questions or planned prompt
topic, and recurring theme were indicated in the margins along with the participant’s
individual experiences.
A copy of the interview transcript with all classifications indicated in the margins was
senttoeachparticipant for clarification and amplification of the analysis. All participants
agreed with the investigators’ interpretations of their narratives and no revisions were
made to any of the categories and themes originally identified.
4. Essential structure: Finally, exhaustive descriptions (Riemen, 1986) of the phenomenon
being studied were developed from an integration of the participants’ individual experi-
ences and the derived recurring themes. These descriptions form a statement of the es-
sential structure of the phenomenon as best as it is understood at the present time, given
the limited sample of the stuttering population interviewed in this study (Moustakas,
1994; Riemen, 1986).
3. Results
The primary purpose of this study was to increase our understanding of successful man-
agement of stuttering by investigating the essential structure of the experiences of seven
adults who stutter as they lived through a journey to successful management. The first level
of analysis involved extracting individual experiences from the narratives provided by the
participants. Table 2 shows examples of 43 individual experiences related to the transi-
tion stage in which participants were beginning the process of successfully managing their
stuttering.
10 L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22
Table 2
Examples of individual experiences related to the transition stage
1. Support groups grounded me
2. Support groups allowed me to talk about stuttering openly
3. Counseling aspect important
4. Had mentors
5. People believed in me
6. Self-therapy
7. Giving myself a lot of assignments
8. Let stuttering happen
9. Self-disclosure
10. Not going to let others treat me poorly
11. Striving for independence
12. Confidence
13. Positive self-talk
14. Challenging self
15. Less intimidated
16. Participation
17. Found the right therapist, right time, right place
18. Desire to perform, to do and succeed
19. Worked very hard on it
20. I practiced
21. I was so focused on wanting to deal with my stuttering
22. Quit hiding stuttering
23. Self-determination
24. Grabbing the bull by the horns
25. Prove something to self and others
26. Sought help for self
27. Became more outgoing
28. More willing to talk to people
29. Willing to take risks with speech
30. Lack of trying was failure
31. Recognition that I had to do something
32. Taking responsibility for speech
33. Overcompensated in areas of athletics, music, singing
34. Self-assertiveness
35. A new character was developing for me
36. Refusal to accept current stuttering
37. Change self-perception
38. Desensitization was really key to me
39. Needed to do voluntary stuttering
40. Started to problem solve independently
41. Started learning about stuttering
42. I felt so good talking about my stuttering
43. There was no stopping me
3.1. Transition stage
The next level of analysis involved sorting the individual experiences into common or
recurring themes. Table 3 shows the six recurring themes that emerged from the partici-
pants’ experiences during the transition stage. Although the participants varied somewhat,
they consistently expressed six themes. These themes were: (1) support from others, (2)
L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22 11
Table 3
Recurring themes from the individual experiences of the participants for the transition stage
1. Support from others
Professional counselling
Support groups
Family
Friends
2. Successful therapy
3. Self therapy and behavioral change
Self-disclosure
4. Cognitive change
Risk taking
Reduction in fear of failure
Take responsibility for speech
Learn more about self as speaker
Positive attitude
5. Utilization of personal experiences
6. High levels of motivation/determination
successful therapy, (3) self-therapy and behavioral change, (4) cognitive change, (5) utiliza-
tion of personal experience, and (6) high levels of motivation/determination. These general
themes are explored in detail in the following sections.
3.1.1. Support from others
Each of the participants discussed a variety of support systems. These included pro-
fessional counseling, local and national support groups, mentors, and family and friends.
The participants stated that the support systems provided them with the chance to connect
with others who stuttered, disclose their stuttering, and exchange information about stut-
tering. One participant described how seeing successful people who stutter planted a seed
for change later in life.
P02 ...getting involved with the self help and support group and reaching out to help
other people grounded me and allowed me to talk about my stuttering openly and
more freely.
Support also was available in the form of counseling, which participants indicated was
helpful. Counseling appeared to be a beneficial component during the transitional process
because it helped the participants revise the negative attitudes, feelings, and thoughts
related to stuttering.
P02 The counseling aspect of this was incredibly important, believed it then and be-
lieved it to this day, without it I don’t see how therapy can be sustained very
long.
In addition to counseling, some of the participants discussed how different people took
on a mentorship role and were supportive of and influential to the management process.
12 L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22
P02 I have had a lot of mentors and a lot of people who believed in me along the way
that have helped to shape me and help shape the person that I am.
P04 I am a firm believer in having the right people in the wings and anyone who does
extraordinary things, never does it without people in the wings.
Participants described their mentors as possessing attributes of having respect for them,
knowledgeabout the nature of stuttering,beingencouraging, supportive, andunderstanding.
3.1.2. Successful therapy
Participants also indicated that they had experienced helpful therapy during the transi-
tional process. Therapy provided the participants with the behavioral tools and cognitive
and affective elements needed to aid the participants in changing both their level of fluency
and the way they felt about themselves as speakers.
P01 But that was so much of the therapy with [name]. So critical, so key for me and I
remember it kind of freed me up in general feeling about myself.
Some of the participants received helpful therapy from multiple speech therapists over
timeor a person other than a speechtherapist.Oneparticipant described how hehadreceived
helpful therapy from a counselor.
P02 ... she was a Ph.D. candidate in counseling psychology ... ended up using Van
Riper’s book ...we used systematic desensitization [to] help me get through little
bits at a time. The counseling aspect was incredibly important.
3.1.3. Self-therapy and behavioral change
Self-therapy was also an instrumental part of the transitional process. All of the partici-
pants discussed how they had to take it upon themselves to work on their speech outside of
the therapy setting. In many cases self-therapy involved both risk taking and self-disclosure
on part of the participant.
P01 I just remember doing a lot of sort of self-therapy during that time. I mean my
clinician wasn’t giving me assignments or anything.
Self-disclosure was a frequent theme during the transitional stage. All of the participants
discussedthe benefits of self-disclosure. Self-disclosureoutsideofthe treatment setting took
the form of the participants letting a listener know of their stuttering, often by stuttering
voluntarily. The participants indicated that self-disclosure provided them with a sense of
freedom, eliminated the element of surprise for the listener, and diminished the fear of
the listener discovering the reality of their stuttering. Participants indicated that by self-
disclosing and taking risks with their speech they achieved a reduction in the amount of
fear associated with stuttering as well as a reduction in the amount of avoidance behaviors.
P04 You can’t get over fear and anxiety if you don’t let stuttering happen.
P05 ...that was really my first experience in self-disclosure. I don’t remember what I said
and I remember I stuttered like crazy but I felt really good afterwards. ...Part of my
therapy was really to try and quit hiding the stuttering and being more open about it.
For me that was really a big thing. That really began to sort of change my attitude.
L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22 13
3.1.4. Cognitive change
All participants discussed a variety of cognitive changes that were part of the transitional
process. All of the participants discussed how they were more willing to take risks, reduce
their fear of failure, take responsibility for their speech, learn more about themselves as a
speaker, and adopt a positive attitude.
P03 I became more outgoing again, I was more willing to talk to people, and I was
willing to take risks with my speech. I realized that if I didn’t try, that was a failure.
Itwasa lack of trying and that was a failure. I hadto go ahead and make the attempt
to speak and see what would happen. ...That was a very important change for me
in terms of how I looked at myself as a speaker.
Aparticipant described his experience during wartime and felt that, having survivedsuch
situations, anything was possible.
P07 ... if I could get through what I got through there, and survive what I survived
there then I could do anything. And so that really fed into me, grabbing onto my
speech and so-called grabbing the bull by the horns. And taking the responsibility
for what was happening to me and hanging in there even though speech therapy
was pretty difficult.
3.1.5. Utilization of personal experiences
Another theme that emerged throughout the narratives was the acknowledgment and use
of successful sub-plots to their overall story. That is, five of the seven participants described
one or more stories of success that they had experienced in their lives and were able to apply
to the task of re-authoring their story about stuttering. Many of the participants discussed
how they had recognized positive attributes that helped compensate for the negative impact
that stuttering was having on their lives. Although their talents and strengths may not have
had an obvious connection with their fluency, these personal attributes, combined with
experiences and persistence, provided a history of success in other aspects of their lives.
These successes, in turn, provided the participants with alternative scripts to their history
of stuttering-related failure.
P05 The only saving grace is I went out for track and was pretty good at it and got to
know a bunch of guys and that sort of carried me all the way through high school.
3.1.6. High levels of motivation/determination
High levels of motivation and determination were also apparent throughout the narra-
tives of all of the participants. The participants sought help for themselves and had an
overwhelming desire to succeed.
P02 By God if they can’t help me I will stand alone and do it myself. So there was a
lot of the self-determination in me. I always felt like I needed to prove something
to everybody and I’m sure my stuttering was a major component of that.
The final level of analysis involved integrating the results of the earlier analyses into a
description of the phenomenon that precisely describes its essential structure (Cresswell,
1998). Table 4 shows the essential structure of the process that leads to successful man-
agement of stuttering, as experienced by the participants in this study. The process, as
14 L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22
Table 4
The essential structure of the transitional process that led to successful management of stuttering
Transitioning from a life dominated by the theme of stuttering to one in which stuttering was successfully
managed required both cognitive and behavioral changes. Successful management of stuttering occurred
gradually resulting in stuttering becoming a minor, rather than a dominant theme. Ongoing motivation and
persistence resulted in finding help in many forms, particularly from mentors (both professional and
nonprofessional) who provided support and guidance. Although no particular treatment protocol or technique
was associated with success, taking advantage of this help resulted in acceptance and taking responsibility for
change. Accomplishments in many other areas were employed as counter themes to the perceived lack of ability
to communicate successfully. Change is evident not only in the reduction of stuttering frequency, but in the
ability to disclose the problem and take risks regarding communicating outside of the treatment setting.
summarized in Table 4, involves many levels of cognitive and affective change that employ
personal characteristics along with assistance and support of others.
3.2. The past and current situations
In order to fully understand the nature of successful management, a secondary purpose
of this study was to describe, from the perspective of the person who stutters, the experience
of stuttering both before and following successful management. As before, the individual
experiences of each participant were examined. Many of the individual experiences from
the past, when stuttering was being unsuccessfully managed, provide a story of negative re-
actions and emotions accompanied by a lifestyle characterized by restriction and avoidance.
Statementsof negativereactionsandemotions (e.g., parental embarrassment, low opinionof
self, shame, guilt, inadequate, anxiety, dread, stuttering dictated self-worth) predominated.
Participants recalled making decisions to restrict and avoid a variety of situations (e.g., not
participating, reluctant to talk in class, wouldn’t answer questions, couldn’t read out loud).
P02 [I] was unable to speak openly or freely and say what I wanted to say, when I
wanted to say it, or to who I wanted to say it. That was a very troubling time for
me from an emotional standpoint and from a not knowing quite what was going
to happen to me kind of standpoint.
P04 I was described as like a little mouse in a corner with no where to go. What was
I going to do? Everything seemed too impossible because everything was about
talking.
P05 My family actually never talked about stuttering. But certainly stuttering was a
very negative thing and it and other experiences probably gave me at one time a
very low opinion of myself. Certainly very low self-esteem. Feelings of shame and
guilt certainly a lot of anxiety.
The individual experiences from the current situation lacked the negative characteristics
and, conversely, indicated unrestricted participation and optimism (e.g., sense of freedom,
competence, mastery of fear, optimistic, empathy for others, stuttering is a gift, stuttering
is an asset, stuttering has made me a better person).
L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22 15
P01 ...for me, you know, change is about how I feel about myself. And self acceptance
and all that kind of stuff are probably more important than techniques. And for
me, when I can, whenever I need to use a technique, I’m free enough often to be
able to use it.
P02 Today, I would have to say that the stuttering I suffered from has turned into one
of my biggest assets and I think it has served me well. It truly has become a gift
for me.
P03 But in general, 95% of the time or more stuttering is not an issue. It’s there, I know
it’s there and it’s part of who I am, but it’s not an issue in terms of decisions I make
or in terms of what I’ve achieved. It just doesn’t play a major role in my life. It’s
not something that dictates what I do from day to day.
As with the transitional stage, individual experiences were sorted into common or recur-
ring themes. This was done separately for the past stage and the current stage, yielding a list
of recurrent themes for each stage that, again, reflected the contrasting experience of stut-
tering before and following successful management (Table 5). The six recurring themes for
past experiences (when stuttering was unsuccessfully managed) were: (1) gradual aware-
ness, (2) negative reactions of listeners, (3) negative emotions, (4) restrictive lifestyle, (5)
avoidance, and (6) inadequate therapy. The five recurring themes identified for the current
situation where stuttering is successfully managed were: (1) continued management, (2)
self-acceptance and fear reduction, (3) unrestricted interactions, (4) sense of freedom, (5)
and optimism.
The essential structures of both the past and current experiences for the participants in
this study are contrasted in Table 6. The predominant themes of the past experience are
of struggle and suffering. These themes are reflected in the participants’ choice of a re-
strictive lifestyle characterized by avoidance and concealment of stuttering. Anxiety and
a wide variety of negative emotions are common. The predominant themes of the current
experience are optimistic and positive. In spite of some degree of ongoing management
of stuttering, stuttering is no longer a major theme. The participants’ lifestyle is gener-
ally one of unrestricted choice and a sense of freedom to act and speak on one’s own
behalf.
Table 5
Recurring themes from the individual experiences related to (a) the past when stuttering was unsuccessfully
managed and (b) the current situation where successful management was achieved
Unsuccessful management Successful management
1. Gradual awareness 1. Continued management
2. Negative reactions of listeners 2. Self-acceptance and fear reduction
3. Negative emotions 3. Unrestricted interactions
4. Restrictive lifestyle 4. Sense of freedom
5. Avoidance 5. Optimism
6. Inadequate therapy
16 L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22
Table 6
The essential structure of (a) the past experience when stuttering was unsuccessfully managed and (b) the current
experience as stuttering is successfully managed
The past experience when stuttering was unsuccessfully managed
Theexperience of stutteringmay becharacterized by a story ofstruggle andsuffering. Struggling tocope withthe
difficultiesposed by theproblem ofstuttering, personswho stuttertend tolead arestrictivelifestyle characterized
by attempts to avoid stuttering and to avoid revealing their stuttering to the world. These struggles, along with
negative reactions from a variety of listeners, including family members, and failure associated with inadequate
therapy early in their lives can lead to emotions of helplessness, anxiety, low self-worth, embarrassment, and
disapproval and an overall life tenor of suffering.
The current experience as stuttering is successfully managed
Successful management of stuttering is characterized by an optimistic and positive interpretation of life. In spite
of the fact that self-management of stuttering continues, the possibility of stuttering is no longer a major theme.
There is a sense of appreciation for what has been accomplished. Although speakers are considerably more
fluent than in the past, more dominant themes indicate that life choices are no longer restricted by anxiety or
fear associated with stuttering or the possibility of stuttering. There is an obvious sense of freedom to act and
speak on one’s own behalf.
4. Discussion
The primary purpose of this investigation was to discover, from the speaker’s perspec-
tive, themes that help us, as clinicians, to understand the ability of selected speakers to
successfully manage their stuttering. To place this information into perspective we also
identified, again from the perspective of the speaker, themes which described the initial
years when stuttering was unsuccessfully managed and contrasted them with the current
situation where stuttering is being successfully managed.
4.1. Contrasting unsuccessful and successful stuttering management
The participants’ descriptions of unsuccessful stuttering management coincide with the
analyses of other authors who have investigated the perceptions of participants who were
struggling with the problem (Anderson & Felsenfeld, 2003;Corcoran & Stewart, 1998;
Crichton-Smith, 2002; Finn, 1996). Participants consistently described themes of gradual
awareness, negative reactions of others, negative emotions, suffering, struggle, avoidance,
and restriction across many aspects of their lives. Although these themes typically included
speaking situations, the descriptions went beyond the difficulties of communicating and
extended to the individuals’ overall responses to their global life experiences, including
self-interpretation. In each case, a major theme of their life story to this point was that of
stuttering. Participants regularly provided examples of helplessness, anxiety, and low self-
worth. This, of course, is not surprising, given the classic earlier descriptions (e.g., Johnson,
1930) of the stuttering experience. From the perspective of the speaker, the severity of the
problem is represented by these intrinsic features as much or more than it is by the more
obvious surface behaviors. The consistency of these findings strongly indicates that a com-
prehensive clinical assessment of stuttering include the determination of the handicapping
as well as the disabling aspects of the problem. Furthermore, any determination of the bene-
fits of treatment should include validation by the client of changes in the intrinsic features of
L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22 17
the problem (see also, Conture, 1996). Accordingly, the importance of continued develop-
ment and refinement of procedures for assessing the intrinsic features of stuttering for both
diagnostic and outcome measures is evident (e.g., Andrews & Cutler, 1974;Craig, Franklin,
& Andrews, 1984;Crowe, DiLollo, & Crowe, 2000;DiLollo, Manning, & Neimeyer, 2003;
Ornstein & Manning, 1985;Yaruss, 2001;Yaruss & Quesal, 2002).
The participants’ descriptions of successful stuttering management provide a sharp con-
trast to their earlier situations. Participants currently present an optimistic and positive
interpretation of themselves and their lives. There is little or no indication of the numerous
negative emotions that accompanied the descriptions of their experiences during the initial
years of stuttering. It is apparent that they have reorganized and continue to expand their
view of themselves and their overall potential on many levels. As reported by the authors
of previous investigations of successful outcome for people who stutter, most of the partic-
ipants do not report absolute fluency but, on occasion, continue to self-assess and manage
theirmuch-improvedfluency.The fact that the participants indicatedthat theyweresuccess-
ful in spite of some stuttering informs us about both the nature of the stuttering phenomenon
and the variety of possible indicators for assisted (and unassisted) outcome.
The participants’ descriptions of both their initial and current experiences with stuttering
go far beyond the surface features of the problem (e.g., the frequency and overt character-
istics of their stuttering). The descriptions unmistakably indicate that absolute fluency is
not a necessary nor sufficient criterion for success. Alternatively, it is unlikely that some
of the participants who self-report recovery would meet the threshold of fluency that all
professional clinicians or researchers judge as acceptable. Nonetheless, these participants
indicated a clear sense of accomplishment and genuinely feel that their lives are unrestricted
by the occasional occurrence (or even the possibility) of stuttering. Indeed, it was not un-
common for participants to express appreciation for the fact that they are people who stutter
and go so far as to interpret the experience as a “gift.” It is important to our understanding
of successful therapeutic outcome to appreciate that such an interpretation is an important
part of the human change process.
4.2. The nature of the transition to successful management
Investigations into recovery from or successful management of stuttering (i.e., Anderson
& Felsenfeld, 2003;Crichton-Smith, 2002; Finn, 1996;Shearer & Williams, 1965;Sheehan
& Martyn, 1966, 1970;Wingate, 1964) indicate that participants attribute their success to
a variety of factors including behavioral modifications of the way they are speaking (e.g.,
self-assessment,fluencyand stuttering modification techniques), motivation,environmental
change, and changes in attitudes toward both the self and the problem. Similar descriptions
were provided by the current participants. Participants reported a developing willingness
and persistence for taking responsibility for finding help from both professional and non-
professional mentors. Participants became increasingly assertive by taking risks and dis-
closing their stuttering and entering into difficult speaking situations; themes associated
with successful change that were reported by Anderson and Felsenfeld (2003). Participants
characterized their transition from a story where a major theme was stuttering to their cur-
rent state of successful management of stuttering by citing both cognitive and behavioral
changes.
18 L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22
There were many reported examples of participants incorporating success in other areas
of their lives into the process of changing a life influenced by stuttering. A part of each
participant’s successful transition was the accounting of events and experiences that al-
lowed the development of counterplots that disclosed an alternative and richer story (Monk,
Winslade, Crocket, & Epston, 1997). These events described unique outcomes of achieve-
ment that were counter to the dominant plot of failure associated with speaking. As these
experiences became recognized and valued by the participants, they slowly developed new
responses to their problem (e.g., becoming assertive rather than passive, persistent rather
than fearful) and began to develop a story that was no longer characterized by the themes of
failure, helplessness, and shame. The concept of agency has been described as “the extent
to which individuals can act for themselves and speak on their own behalf” (Monk et al.,
1997, p. 301). Monk et al. (1997) indicate that this agentic response is developed in spite
of the dominant discourse and associated themes, and it often involves a deliberate break
from the influence of such themes. Drewery, Winslade, and Monk (2000) take a similar
position arguing that “health, in our view, has much to do with the capacity for agency and
less to do with the absence of disease” (p. 256). As the responses of the participants in this
investigation indicate, agency, or the ability to live life and achieve a voice in a literal as
well as a metaphorical sense, is not dependent on total and complete fluency.
4.3. Clinical implications
The seven participants who took part in the present study were unique in the sense that
they were either professional speech-language pathologists who specialize in fluency disor-
ders or were active in the self-help movement. All of the participants obtained a minimum
of at least one post-graduate degree, suggesting that they are particularly motivated and
determined individuals. Such factors may help to explain why, in many ways, these people
mayhaveexperienced a greater degree of successful management than the participants stud-
ied by Anderson and Felsenfeld (2003). Three of Anderson and Felsenfeld’s participants
indicated that avoidance remained a feature of their stuttering. None of the participants in
the present study indicated that avoidance was a factor in their current lifestyle. Because of
their continuing advocacy and assistance to others with the problem of stuttering, ongoing
involvement in self-help and support groups, and frequent public speaking activities, the
participants in the present study may have become particularly desensitized to stuttering
and represent the upper boundary of successful management of stuttering. The unique char-
acteristics of the participants in the present study offer a limited understanding of successful
stuttering management. It remains to be seen whether similar themes may be discovered in
more diverse and representative individuals who have made a similar transition.
The current results, as well as those from earlier studies of recovery (e.g., Shearer &
Williams, 1965;Sheehan & Martyn, 1966, 1970), suggest that individuals who have been
able to successfully manage their stuttering adjust the way they approach themselves and
their speaking ability. These individuals describe taking responsibility for change. They tell
us that they are able to alter the way they think about who they are and what they are capable
ofaccomplishing. Withthe assistanceof professional cliniciansorwith mentorswhoprovide
supportand guidance,theybeginto recognize abilitiesand accomplishments thatrun counter
to the story that has featured stuttering. They gradually begin to incorporate alternative
L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22 19
explanations and responses to their experience of stuttering. Rather than hiding themselves
and their stuttering, they continue to be motivated and determined to take risks and disclose
their stuttering. They make behavioral changes in their speech and gain confidence in using
techniques that help them to alter their habitual patterns of speaking and stuttering. The
behavioral changes coincide with cognitive changes in how they view themselves and their
problem. Although there is likely to be a great deal of variability in their fluency, they
gradually but persistently are able to make these behavioral and cognitive changes as they
interact with others in their daily environment.
Similar to the participants in the Crichton-Smith (2002) and Anderson and Felsenfeld
(2003) studies, participants in the current study indicated that treatment was eventually
helpful in reaching their goals of successful management. Interestingly, however, there was
no pattern regarding the approach or techniques that participants found helpful. Participants
had difficulty identifying specific approaches or techniques to which they could attribute
their success. These findings suggest that any rational and empirically informed procedure
that enables the client to self-assess and systematically modify speech behaviors and the
associated cognitive features may be likely to successfully facilitate fluency. Interestingly,
Wampold (2001) has suggested a similar process regarding the effectiveness of counsel-
ing and psychotherapy. Wampold (2001) found little support for the medical model which
suggests that specific therapeutic ingredients are necessary for the remediation of a prob-
lem. Rather, he and his colleagues identified common factors across treatment approaches
(working alliance, clinician allegiance, and competence of the therapist) that do much better
in accounting for the variance in successful treatment outcome.
4.4. Implications for future research
One implication of the results from this and related studies is that a primary challenge
for clinicians may be less one of identifying a particular therapeutic approach and specific
techniques to “succeed” with clients and more one of how to develop a therapeutic en-
vironment that will facilitate changes in the essential structure of the speaker’s stuttering
experience. Rather than asking questions such as “Which treatment is the best?” it may be
more productive to identify and match the characteristics of a client with the competencies
and therapeutic philosophy of a clinician (or mentor) in order to promote a working alliance
that is likely to result in a successful therapeutic outcome.
Given the nature of this qualitative study, the results are limited to those individuals
who were directly studied rather than generalized to other people or populations (Patten,
2002). We were, however, interested in the clinical utility of the findings (to what extent
might the results be applied to a theoretical, or underlying operational, understanding) (see
Domico, Simmons-Mackie, Oelschlaeger, Elman, & Armstrong, 1999) of a person’s ability
to successfully manage stuttering. The essential structure of successful stuttering manage-
ment may be different for others. The purpose of this study was to describe the common
experiences of this particular group of persons who stutter, with the idea that we may learn
important themes from these individuals as they made their journey to successful manage-
ment of stuttering. That these individuals were not representative of the wider population of
persons who stutter could be relatively unimportant for a number of reasons. Firstly, there is
little evidence to show that it would ever be possible to select a “representative” sample of
20 L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22
personswho stutter.On what specific variableswould such selection bebased?Secondly,the
findings of this study indicate the clinical utility of these common themes for helping indi-
viduals who stutter successfully manage their problem—not specific treatment techniques.
However, as with any strategy (or technique, for that matter), until they are attempted with
a given individual it is impossible to know if they will be effective. Ultimately, it is the
responsibility of the reader to determine the degree to which the themes, reflected in the
essential structure of successful stuttering management, may be integrated into treatment.
Similarly, these findings are not meant to reflect a prescription for successful manage-
ment of stuttering. On the contrary, as reflected in the varying stories related to us by the
participants in this study, it is our belief that every individual person who stutters will take
a different road on his or her journey to successful management. This belief, however, does
not preclude the usefulness of these findings as guideposts for persons who stutter who may
be on their journey and choosing roads to travel. Undoubtedly, future research similar in de-
sign to this study but drawing on different samples, will find additional guideposts that will
also prove useful to some persons who stutter in their journey to successful management.
CONTINUING EDUCATION
A phenomenological understanding of successful stuttering management
QUESTIONS
1. Rather than the term “recovery” (from stuttering) the authors preferred the term “suc-
cessful management” because:
a. it is suggested by the medical model for conceptualizing stuttering
b. it avoids problems associated with the subjective interpretation of the speaker
c. it provides a better indication of long term success following therapy
d. it accommodates the problems associated with relapse following treatment
e. it does not imply a complete absence of stuttering
2. Which of the following was NOT a reason the authors selected a phenomenological
approach to investigate the phenomenon of successful stuttering management:
a. the successful management of stuttering is highly complex
b. the lack of assessment measures for determining long term success
c. the data is derived from the unique lived experience of the participants
d. issues associated with group data for understanding an individual experiences
e. it emphasizes the knowledge of the individuals experiencing the phenomenon
3. Participants indicated that they achieved successful management via which of the fol-
lowing recurring themes:
a. using specific techniques to modify their speaking behavior
b. high levels of motivation/determination
c. intensive treatment programs
d. utilization of personal experience
e. support and mentoring from others
4. Theadults whohad successfullymanagedtheir stutteringindicated thattheyexperienced:
a. little stuttering in nearly all speaking situations
b. self acceptance and fear reduction
L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22 21
c. continued management of their stuttering
d. unrestricted interactions with others
e. optimism and a sense of freedom
5. The findings fail to indicate that:
a. the benefits of treatment should include validation by the client of changes in the
intrinsic features of the problem
b. absolute fluency is not a necessary nor sufficient criterion for success
c. the concept of “agency” may explain the success experienced by the participants
d. the results can easily be generalized to many adults who stutter
e. no single treatment approach or technique was associated with success
References
Anderson, T. K., & Felsenfeld, S. (2003). A thematic analysis of late recovery from stuttering. American Journal
of Speech-Language Pathology,12, 243–253.
Andrews, G., & Cutler, J. (1974). Stuttering therapy: The relation between changes in symptom level and attitudes.
Journal of Speech and Hearing Disorders,39, 312–319.
Bogdan, R., & Biklen, S. (1998). Qualitative research for education (2nd ed.). Boston: Allyn and Bacon.
Conture, E. G. (1996). Treatment efficacy: Stuttering. Journal of Speech and Hearing Research,39, S18–S26.
Corcoran, J. A., & Stewart, M. (1998). Stories of stuttering: A qualitative analysis of interview narratives. Journal
of Fluency Disorders,23, 247–264.
Craig, A. R., Franklin, J. A., & Andrews, G. (1984). A scale to measure locus of control behavior. British Journal
of Medical Psychology,57, 173–180.
Cresswell, J. W.(1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks,
CA: Sage.
Crichton-Smith, I. (2002). Communicating in the real world: Accounts from people who stammer. Journal of
Fluency Disorders,27, 333–352.
Crowe, T. A., DiLollo, A., & Crowe, B. T. (2000). Crowe’s protocols: A comprehensive guide to stuttering
assessment. San Antonio, TX: The Psychological Corporation.
DiLollo, A., Manning, W. H., & Neimeyer, R. A. (2003). Cognitive anxiety as a function of speaker role for fluent
speakers and persons who stutter. Journal of Fluency Disorders,28(3), 167–186.
Domico, J. S., Simmons-Mackie, N., Oelschlaeger, M., Elman, R., & Armstrong, E. (1999). Qualitative methods
in aphasia research: Basic issues. Aphasiology,13(9–11), 651–665.
Drewery, W., Winslade, J., & Monk, G. (2000). Resisting the dominating story: Toward a deeper understanding of
narrative therapy. In R. Neimeyer & J. D. Raskin (Eds.), Constructions of disorder (pp. 253–263). Washington,
DC: American Psychological Association.
Finn, P. (1996). Establishing the validity of recovery from stuttering without formal treatment. Journal of Speech,
Language, and Hearing Research,39, 1171–1181.
Johnson, W. (1930). Because I stutter. New York: Appleton-Century-Crofts.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.
Martin, R. R., Haroldson, S. K., & Triden, K. A. (1984). Stuttering and speech naturalness. Journal of Speech and
Hearing Disorders,49, 53–58.
Monk,G. (1997). Hownarrativetherapy works. InG. Monk,J. Winslade, K.Crocket, & D.Epston (Eds.),Narrative
therapy in practice (pp. 3–31). San Francisco, CA: Jossey-Bass Publishers.
Monk, G., Winslade, J., Crocket, K., & Epston, D. (1997). Narrative therapy in practice. San Francisco, CA:
Jossey-Bass Publishers.
Moustakas, C. (1994). Phenomenological research methods. Thousand Oaks, CA: Sage.
Ornstein,A., & Manning,W.(1985).Self-efficacyscaling by adultstutterers. JournalofCommunication Disorders,
18, 313–320.
Patten, M. L. (2002). Understanding research methods: An overview of the essentials. Glendale, CA: Pyrczak
Publishing.
22 L. Plexico et al. / Journal of Fluency Disorders 30 (2005) 1–22
Quarrington, B. (1977). How do the various theories of stuttering facilitate our therapeutic approach? Journal of
Communication Disorders,10, 77–83.
Quesal, R. W. (1989). Stuttering research: Have we forgotten the stutterer? Journal of Fluency Disorders,14,
153–164.
Raskin, J. D., & Lewandowski, A. M. (2000). The construction of disorder as human enterprise. In R. Neimeyer
& J. D. Raskin (Eds.), Constructions of disorder (pp. 15–40). Washington, DC: American Psychological
Association.
Riemen, D. J. (1986). The essential structure of a caring interaction: Doing phenomenology. In P. M. Munhall &
C. J. Oiler (Eds.), Nursing research: A qualitative perspective (pp. 85–105). Norwalk, CT: Appleton-Century-
Crofts.
Riley, G. (1994). Stuttering Severity Instrument for Young Children and Adults (SSI-3) (3rd ed.). Austin, TX:
Pro-Ed.
Shearer, W. M., & Williams, J. D. (1965). Self-recovery from stuttering. Journal of Speech and Hearing Disorders,
30, 288–290.
Sheehan, J. G., & Martyn, M. (1966). Spontaneous recovery from stuttering. Journal of Speech and Hearing
Research,9, 121–135.
Sheehan, J. G., & Martyn, M. (1970). Stuttering and its disappearance. Journal of Speech and Hearing Research,
13, 279–289.
Spradley, J. P. (1979). The ethnographic interview. New York: Holt, Rinehart & Winston.
Starkweather, C. W. (1999). The effectiveness of stuttering therapy: An issue for science? In N. B. Ratner & E.
C. Healey (Eds.), Stuttering research and practice: Bridging the gap (pp. 231–244). Mahwah, NJ: Lawrence
Erlbaum.
Valle, R., & King, M. (1978). Existential phenomenological alternatives for psychology. New York: Oxford
University Press.
Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Lawrence
Erlbaum.
Wingate, M. E. (1964). Recovery from stuttering. Journal of Speech and Hearing Disorders,29, 312–321.
Yaruss, J. S. (2001). Evaluating treatment outcomes for adults who stutter. Journal of Communication Disorders,
34(102), 163–182.
Yaruss, J. S., & Quesal, R. W. (2002, November). Overall assessment of the speaker’s experience of stuttering
(OASES). Seminar presented at the annual meeting of the American Speech-Language-Hearing Association.
Laura Plexico is currently a doctoral student at the University of Memphis where she is focusing on studies
concerning fluency disorders, speech acoustics, neurophysiological substrates of stuttering, and counseling. She
receivedherundergraduate degree from the Universityof Montevallo, AL. She has presented research to the profes-
sionalmeetingsof the AmericanSpeech-Language-Hearing Association andthe International FluencyAssociation.
Walter H. Manning, Ph.D. is a professor and Associate Dean in the School of Audiology and Speech-Language
Pathology at The University of Memphis. He teaches courses in fluency disorders and research methods. He has
published more than 80 articles in a variety of professional journals and has presented on many occasions to
regional, national, and international meetings. He is a reviewer for several professional journals and has served
as an Associate Editor for The Journal of Fluency Disorders. He is the author of a text titled Clinical Decision
Making in Fluency Disorders (2001) published by Singular/Thompson Learning. He has served on the Steering
Committeeof Division 4 (Fluency & Fluency Disorders), the Specialty Board on Fluency Disorders, and is a Board
Recognized Specialist in Fluency Disorders. He is a fellow of ASHA and has received the honors of Tennessee
Association of Audiologists and Speech-Language Pathologists.
AnthonyDiLollo is an assistant professor in the Departmentof Communication Disorders and Sciences at Wichita
State University. He is a member of the International Fluency Association (IFA) and the North American Personal
Construct Network (NAPCN), and a reviewer for the Journal of Fluency Disorders. He received an undergraduate
degree in Psychology from the University of Western Australia, a Master’s degree in Speech-Language pathology
from the University of Mississippi, and a Doctor of Philosophy degree from the University of Memphis. He is a co-
author of “Crowe’s Protocols: A Comprehensive Guide to Stuttering Assessment” published by the Psychological
Corporation, and has extensive experience working with persons who stutter.
