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Psychologist (P): Hi Lukas.  My name is Dr. Samson.  Just to give you a little background information on myself, I received my undergraduate degree in communication disorders and then went on to get my PhD in clinical psychology.  Since this is our first session together, I just want to get some background information about you and try to get a better sense of what has been troubling you.  So tell me, why are you here today?

Lukas (L): Well, I am 23 years old, and I have been a stutterer for as long as I can remember.  Over the course of my life, I have to watch the pain in listeners' faces as I struggle with dysfluent moments.  People look away, try to finish my sentences, and some people act like they don’t even want to talk to me.  My whole life I have struggled with social anxiety and I also feel shame and depression; I feel as though all of these problems have stemmed from my stuttering experiences.  I actually am to the point that I don’t even want to talk to anyone. 

P: I want you to know that you are not alone.  There has been a considerable amount of research done on the attitudes of people who stutter.  Research has proven that both children and adults who stutter tend to have more negative attitudes toward speaking than nonstutterers (Murphy, 1999).  You feelings are totally understandable and very typical of other stutterers.

L: Well, I am definitely not very outgoing.  I tend to avoid social situations because I am afraid that people are going to react negatively to my stuttering (Silverman, 1996).  I have an extremely high level of anxiety when talking to others, because I am trying to conceal the fact that I am a stutterer.

P: Well, anxiety can result from anticipating stuttering in a speaking situation and desiring to avoid it (Silverman, 1996, p. 71).  You are not alone in your feelings.  As you continue to come to sessions with me, we are going to work through this feeling of anxiety you experience, and hopefully come to the point where you do not feel overwhelmed by anxiety during conversational speech.  Earlier, you mentioned that you feel some shame about your stuttering.  Can you tell me a little bit more about that comment? 

L: Well I am ashamed of my stuttering for numerous reasons.  I feel so powerless, small and useless, and this in turn makes me want to avoid situations.  I am ashamed that I speak the way I do and am powerless to do anything to stop my moments of dysfluency.

P: Shame is a very powerful emotion.  With shame, a person focuses his evaluation on the whole self, so if failure occurs, the person feels utterly defective.  Shame can cause feelings of worthlessness and powerlessness, leaving a person feeling exposed.  Shame is also a behavior highly correlated to avoidance behaviors (Murphy, 1999, p.132).  It is very understandable that if you are experiencing high levels of shame, this in turn will result in avoidance behaviors within numerous contexts.  Have you ever taken the time to think about what might have caused your feeling of shame to develop?  Can you think back to the first time that you felt this emotion?

L: Well, I think a lot of this started when I was a child.  When I was in middle school, I was teased by school friends.  I also felt like my parents were embarrassed about my stuttering because they never attempted to speak about it with me.  Then whenever I talked to my mother, it sometimes appeared that she had a pained expression on her face during my moments of dysfluency.

P: All of these factors may very well have contributed to your feelings of shame.  Your parents failing to speak about your stuttering has been described as a “conspiracy of silence” by several researchers, and this silence may actually suggest to the child that stuttering is something too awful to be discussed (Murphy, 1999, p. 138).  In many cases the parents feel that speaking about the stuttering would in turn upset the child, when in actuality, speaking about stuttering can benefit the child.  Before we end this session, I also want you to elaborate on your comment about depression.  You said that you have struggled with depression; can you tell me a little bit more about this?

L: I just feel depressed a lot.

P: Have you ever taken the time to consider what might be causing these feelings? 

L: Not really.  I do get upset when I think about how I do not have much emotional contact with people.  I also get depressed because sometimes I believe my failure to overcome my stuttering is my fault.  Maybe I am not trying hard enough or too weak to overcome my speech problem (Silverman, 1996, p. 70).

P: Thank you for being so honest with me.  In our future sessions, we are going to address the emotional repercussions of your stuttering of which you have so openly shared with me today.  Together, we are going to target the negative way you are viewing yourself and hopefully move toward more self-confidence.  Before you leave, I just have one more question.  Have you ever received any form of speech therapy?   

L: When I was 4 years old, I went to speech therapy for a few months, but I my parents felt there was no significant improvement, so I quit going.

P: Well, as we conclude our first therapy session, I would like to recommend that you consider again going to a speech-language pathologist.  There are several therapy forms that focus on desensitization.  Desensitization therapy’s purpose is to reduce the anxiety component of the stuttering problem.  “The goal is to disassociate stuttering responses from the stimuli that seem to evoke them” (Hulit, 2004, p. 221).  This type of therapy would more than likely be very beneficial to you because it does address the role of anxiety in stuttering.  I feel that speech therapy as well as continued counseling here will be the most successful plan of action for targeting the multi-dimensional aspects of stuttering.  As you leave, I will give you a list of several good speech-language pathologists in this area that primarily deal with fluency disorders.  I hope that you will consider attempting speech therapy again.  It was a pleasure meeting you and talking with you today.  You can schedule your next appointment out front with the receptionist.

L: Thank you so much.