Speech-Related Fears and Anxieties
- Social Anxiety Disorder
- The Iowa Therapies
- Change vs. Acceptance
- Locus of Control
- Denial
- The Most Important Aspect of Your Life
- Freedom to Speak—Badly
In 1928, a Freudian psychologist advanced a theory that stuttering was an attempt to satisfy unresolved oral-erotic needs. [1] If this were true, there would be stuttering phone sex lines. Imagine finding ads in the back of Playboy magazine with scantily dressed women saying, "Call me! I stutter!"
A 1939 personality test study found that stutterers were more neurotic, more introverted, less dominant, less self-confident, and less sociable than non-stutterers. [2] Examination of the personality test found sixteen speech-related questions, including "If you are dining out do you prefer someone else to order dinner for you?" The psychologists had interpreted stutterers' reluctance to order in restaurants as evidence of neuroses, rather than as difficulty talking.
A 1952 study of hostility and aggression found stutterers more likely to turn hostility inward. A 1953 study found the opposite. [3]
Many other psychological studies found stutterers are, on average, psychologically normal, except for speech-related fears and anxieties. We generally have the same speech-related fears and anxieties as non-stutterers, such as fear of talking to strangers and fear of speaking to an audience, but these fears are greater in stutterers. [4]
Social Anxiety Disorder
Individuals with this disorder, also called social phobia, experience fear and apprehension in social situations, especially of being embarrassed or humiliated by their own actions. For some individuals the disorder is general, i.e., they experience distress in all social situations. In other individuals the disorder is specific, such as the common fear of public speaking.
Examples speech-related social anxiety disorder include:
- Some stutterers will drive an hour to see if a store has an item, to avoid a one-minute telephone call.
- I received a call from a woman who was considering divorce. Her husband was a stutterer, and had requested and received a demotion to a job that required no talking to anyone. He'd stopped talking to his wife and children and no longer socialized with friends.
- I received a call from an army colonel who was able to completely hide his stuttering by substituting words. But in presentations he couldn't read his PowerPoint slides aloud. If he read the text as written, he stuttered. If he substituted words, he appeared to be illiterate.
- At a stuttering convention I listened to a man complain about the fluency shaping therapy program he'd attended. "They wanted me to talk like this!" he said, perfectly fluently. He thought that the relaxed, easy speech sounded weird. He said, "I've worked with the same guys for ten years. What would they think if I came to work one day talking like that?"
Being shy about talking to strangers is normal. Feeling embarrassed when you stutter, especially if a listener reacts negatively, is normal. But when hiding stuttering causes you to behave abnormally, you don't have a stuttering problem. You have a hiding problem.
A recent study found that 60% of adult stutterers have social phobia. The study compared two groups of stutterers. The first group received fluency shaping stuttering therapy and cognitive-behavioral therapy to treat social phobia. The second group received only the fluency shaping stuttering therapy. The researchers found that the cognitive-behavioral therapy was effective in treating the first group's social phobia; that the second group had no change in social phobia; and that both groups had equal improvements in speech (i.e., cognitive-behavioral therapy had no effect on subjects' speech). [5]
The Iowa Therapies
The first modern treatments for stuttering aimed to reduce hiding and avoidance. In 1927 Lee Edward Travis became the first director of the University of Iowa Speech Clinic. [6] Travis had a personal interest in stuttering and encouraged three of his students to conduct research and develop new treatments for the disorder.
the new therapeutic approach for which [Bryng] Bryngelson, [Wendell] Johnson, and [Charles] Van Riper opened the way was aimed at a reduction in the fear and avoidance of stuttering…This approach represented a sharp departure from the philosophy on which the older methods were based. Bryngelson, Johnson, and Van Riper were severely critical of those methods…such methods served in the long run to intensify rather than decrease fear because in effect they said to the stutterer, "Don't stutter. Swing your arms or talk in some odd and unnatural way, but whatever you do, don't stutter." And the implication was that hardly anything was more unusual or grotesque or more to be feared and avoided than stuttering. By contrast, the new approach was to say to the stutterer, "Go ahead and stutter. But learn to do so without fear and embarrassment and with a minimum of abnormality." [7]
Bryngelson: Voluntary Stuttering
The first of Travis's students, Bryng Bryngelson, who was not a stutterer, encouraged stutterers to develop an "objective attitude," including
the ability to discuss their stuttering freely and casually with others. It meant the willingness to enter difficult speech situations and the refusal to make use of word substitutions or other tricks for avoiding stuttering. In general, the goal was to bring the problem out into the open and to be willing to stutter. This lent itself to the use of group therapy in which people who stutter were encouraged to ventilate their feelings about their speech problem…It also led to a great emphasis on "situational" work in which clients were taken outside the speech clinic and challenged to demonstrate their ability to maintain an objective attitude in feared situations…the teaching of an objective attitude through situational work is today still used by many speech pathologists [to treat adult stutterers]. [8]
A particularly distinctive contribution that Bryngelson made…was a technique he termed "voluntary stuttering."…If attempts to stutter voluntarily on a difficult word resulted in an involuntary reaction [i.e., real stuttering], clients were to repeat the attempt until the block was completely under their control. In principle, Bryngelson advocated that stutterers learn to imitate…their own…stuttering behavior, but he found that it was easier for stutterers to stutter on purpose when they produced a simple, effortless repetition of initial sounds. [9]
Voluntary stuttering is still taught today. [10] But Bryngelson's clients may have used "simple, effortless" repetitions as a strategy to produce slower, more-fluent speech. A recent article highlighted that true voluntary stuttering requires imitating one's own stuttering behavior:
When using voluntary stuttering for desensitization purposes, the speaker should stutter in a clearly noticeable or "hard" manner so it is clear that he or she is a stutterer. In other words, the speaker should not "cheat" the situation by stuttering softly or in a subtle manner. The speaker also may consider using voluntary secondaries as well, such as voluntary eye blinking and voluntary head movements. [11]
Johnson: Perceptual and Evaluative Reorientation
Travis's second student, Wendell Johnson, focused even more closely on fear of stuttering. [12] Johnson believed that stuttering was caused by the fear of stuttering, even in young children, and this became his diagnosogenic theory.
Johnson is best known for developing >indirect therapy for children who stutter, but he also developed treatment for adult stutterers.
Clients carefully observed their stuttering behavior before a mirror and by means of tape recording to determine just what they did to prevent themselves from speaking…They observed the disfluencies of normal speakers in order to discover that normally fluent speech was not perfectly fluent speech. They made scientific observations of the reactions of their listeners to find out, by and large, listeners were more tolerant of their stuttering than they had assumed.
[In his later years he focused on] training stutterers to be conscious of the inappropriateness of the language they tended to use in talking about their problem…individuals who came for treatment were taught to examine carefully what they meant when they referred to themselves as "stutterers," as though assuming that there was something about them that marked them as basically different from other people, or when they referred to what they did when they talked as their "stuttering" or "it" as though their problem was not what they did when they talked, but a think inside of them that they needed to manage, stop, or control.
Finally…Johnson proceeded to place major emphasis on a great deal of actual speaking by stutterers—an increase both in speaking time and in the number of situations in which speech was attempted—with attention to "going ahead and talking" on the assumption that there were no basic physical or emotional reasons for not doing so. [13]
Van Riper: Stuttering Modification Therapy
Travis's third student went on to have perhaps the most influence of any speech-language pathologist in the field of stuttering. Charles Van Riper developed his therapy between 1936 and 1958. [14] His therapy continued Bryngelson's and Johnson's focus on reducing the speech-related fears and anxieties of adult stutterers, [15] but then added methods to modify stuttering's core behaviors to be less physically stressful. His therapy is one of the most widely practiced stuttering treatments today.
Stuttering modification therapy has four phases: identification, desensitization, modification, and stabilization.
The identification phase is similar to Johnson's clients observing their stuttering behaviors. You begin with identifying the core behaviors, secondary behaviors, and feelings and attitudes that characterize your stuttering. The goal is to improve your awareness of what you do when you stutter. Next, your speech-language pathologist trains you to identify and become aware of your avoidance behaviors, postponement behaviors, starting behaviors, word and sound fears, situation fears, core stuttering behaviors, and escape behaviors. Finally, you identify feelings of frustration, shame, and hostility associated with your speech.
The desensitization phase "toughens" the stutterer, in three stages. First, in the confrontation stage, you're forced to accept that you stutter. You're expected to tell people that you stutter, and talk about what you are doing in therapy to change your stuttering. Next, you freeze your core behaviors—repetitions, prolongations, and blocks. When you stutter, your speech-language pathologist raises a finger. You hold what you are doing, until she drops her finger. For example, if you were repeating a syllable, you have to continue to repeat that syllable. Your speech-language pathologist will make you freeze these core behaviors for longer and longer periods. The goal is for you to become less emotional or more tolerant of these behaviors. The third stage is Bryngelson's voluntary stuttering.
In the modification phase you learn "easy stuttering" or "fluent stuttering," in three stages. First, you learn cancellations. When you stutter, you stop, pause for a few moments, and say the word again. You say the word slowly, with reduced articulatory pressure, and blending the sounds together. Next you learn pull-outs. After you master freezing and cancellations, you use your "easy stuttering" while you are in a stutter, to pull yourself out of the stutter and say the word fluently. The third skill is preparatory sets. After mastering pull-outs, you look ahead for words you're going to stutter on, and you use "easy stuttering" on those words.
In the final, stabilization phase, you seek to stabilize or solidify your speech gains. This is accomplished through three stages. The first is for you to become your own speech therapist. You take responsibility for making your own assignments and prescribed therapy activities. Another sub-goal is "the automatization of preparatory sets and pull-outs." The last subgoal, similar to Johnson's semantic therapy, is for you to change your self-concept from being a person who stutters to being a person who speaks fluently most of the time but who occasionally stutters mildly.
Efficacy of Stuttering Modification Therapy
About a dozen studies have measured the efficacy of stuttering modification therapy. [16] Most of these studies weren't high quality, for example using stutterers' self-reports of improvement without measuring stuttering, or counting the number of subjects who had improved speech but not saying how much their speech improved.
One study found an average 35-40% reduction in stuttering post-therapy. No follow-up evaluation was done to see how long this effect lasted.
Another study found an impressive reduction in average stuttered syllables from 12% to 1%, but nine months later the average stuttering was back up to 7%.
Another study found that listeners preferred to listen to untreated stuttering rather than listen to a stutterer using stuttering modification therapy techniques. [17] In other words, stuttering modification therapy might make your speech sound worse.
In the article Why Stuttering Experts Don't Agree you can read an exchange of letters about a clinical trial of a stuttering modification therapy program. The researchers followed nineteen adult stutterers in the 3.5-week Successful Stuttering Management Program (SSMP, developed by Dorvan Breitenfeldt and Delores Rustad Lorenz). Immediately post-treatment their speech improved 10%. Six months later this modest gain had all but disappeared. Several measures of anxiety found a 10-15% psychological improvement. The researchers cautioned that six months isn't a long follow-up, and that this psychological improvement might not last, given the absence of improved speech. The researchers concluded, "…the SSMP appears to be ineffective in producing durable improvements in stuttering behaviors." [18] In the exchange of letters you can read a disagreement about what the goals of stuttering modification therapy are.
Change vs. Acceptance
Should stutterers change their speech? Or should stutterers accept themselves as they are and not try to be someone else?
A similar argument is heated in the deaf community, regarding whether deaf children should receive cochlear implants. The view that deaf individuals aren't disabled but rather are "differently abled" is supported by brain scans finding that deaf individuals' auditory processing areas are used for other sensory processing, giving such individuals sensory abilities that hearing people lack. Also, the deaf community ("deaf culture") is strong, with its own language, schools, and organizations. On the other hand, parents refusing to allow a deaf child to receive a cochlear implant (which more or less cures deafness) seem immoral.
No one says that stuttering children shouldn't receive treatment. But some adults advocate accepting stuttering rather than treating stuttering. For example, the 2006 National Stuttering Association annual convention offered the following workshops: "Flying with Attitude," "Building Self-Confidence," "Getting to the Bottom of Your Fears," "Coping with Stuttering in a Social World," "Stepping Out of Our Comfort Zone," and a workshop that demonstrated how to
"switch gears" to a self-approving position by giving oneself credit for any degree of progress made or trying to be made rather than yielding to all the familiar negative and self-defeating thoughts which tend to overwhelm any degree of success. [19]
Change and acceptance work together. When my speech was out of control, I tried to ignore my stuttering (see Denial). But when I developed some fluency, I wanted to tell my friends what I'd done. My friends' positive responses made me feel some acceptance that I stuttered. Acceptance helped me work more to improve my speech, and improved speech gave me more acceptance. Change and acceptance work together, in a "virtuous" circle.
In contrast, change without acceptance doesn't work, and acceptance without change doesn't work. The former individuals seek instant, effortless, invisible, 100% miracle cures. They don't want anyone to know that they went to speech therapy or are wearing an anti-stuttering device. These are the people who want anti-stuttering medications.
The latter individuals go to National Stuttering Association conventions. I went to three conventions and then stopped going. I wanted to talk about stuttering treatments, while everyone else was heartily accepting each other as they were.
Are Clinicians Responsible for Clients' Speech?
Speech-language pathologists have a parallel issue. Catherine Montgomery, CCC-SLP, of the American Institute for Stuttering in New York City, wrote of her experiences:
I had been taught as a young clinician that my clients' progress was pretty much 100% my responsibility. This created my burn out and a neediness on my part for them to do well. If they did well, then I was OK. It meant I was a good clinician. This sense of neediness undoubtedly set up a dynamic in the clinical relationship that was not healthy for me or for them.
I now believe that for most of our clients who stutter, from school age on up, that one of our primary jobs is to facilitate their independence and empowerment. Thankfully, I learned how to let go. I now know to develop a partnership attitude with each client, that I am here to do the very best I know to do for and with them, but that there has to be a point where I step back and let them take over. You know, "you can take the horse to the water…" [20]
Locus of Control
Locus of control is associated with assignment of causality of a given condition.
A person with an external locus of control sees stuttering as something that happens to him, and therapy as something that a speech-language pathologist does to him. In contrast, a person with an internal locus of control sees stuttering and stuttering therapy as something that he does and has at least some control over.
A study found that internal vs. external locus of control did not predict fluency two years after completing a stuttering therapy program. [21] However, be aware if you find yourself trapped by one or the other.
- If you say, "I've been to stuttering therapy, I just have to try harder to use my therapy skills" then you're headed for an internal locus of control trap. You may refuse to let people help you, e.g., joining a stuttering support group, or accepting a free anti-stuttering telephone device from your state.
- An external locus of control trap is to try a stuttering treatment, it doesn't work, and you give up and conclude that no stuttering treatment works.
Inward vs. Outward Anger
Stuttering, like any frustrating experience, causes anger. Some individuals direct these feelings inward (i.e., they hate themselves). This leads to a vicious cycle or "self-fulfilling prophecy" of failure.
But other stutterers direct these feelings outward. These individuals feel anger at other people. Their relationships at work or socially go poorly, again creating a vicious cycle of failure.
How do you feel when people disrespect you when you stutter? Do you feel anger at yourself for stuttering? Or do you feel anger at the person who treated you poorly?
When you're angry, do you do nothing, but get angrier inside? That's inner-directed self-hatred.
Or do you take action to "send a message" nonverbally—which the other person is certain to misunderstand? I once "sent a message" to my housemates that it was their turn to buy toilet paper. Don't ask me what I did! They didn't get the message. They just got angry back at me. That didn't lead to domestic bliss.
Use slow, stretched syllables when telemarketers call. Do you look forward to annoying telemarketers? If so, you direct your anger outward. But if you're afraid to annoy telemarketers, then you direct your anger inward.
If practicing speech therapy with a telemarketer scares you, have your speech-language pathologist pretend to call you. She'll try to sell you slow pitch bats, slow blow fuses, stainless steel slow cookers, and slow jam CDs. If you can't think of anything to say, ask, "How slow are the slow pitch bats?"
Then call her, reversing roles. Convince her that your slow cookers are the slowest, and that no one makes a slower slow jam CD. Practice this until you're willing to practice therapy skills with a telemarketer.
Denial
I had a neighbor with schizophrenia. He'd lost his job as a chemical engineer and now worked as a minimum wage security guard. He'd never asked a woman out on a date since the voices in his head started. He had no friends other than me.
Like 40% of people with schizophrenia, he denied that he had the disorder. He was convinced that when he'd gone in for a root canal, the dentist had inserted a radio receiver in his tooth, and now the CIA was broadcasting voices into his head.
My neighbor enjoyed reading French and Italian newspapers at a university library. He'd take the newspapers to the basement where no one would hear him repeating obscenities to annoy the CIA agents listening to his thoughts. One day, security guards asked him to leave. To get away from them he ran into traffic in a busy street. He wasn't allowed into the library after that.
Consider what would have happened if he'd told a librarian that he had a mental illness that made him talk to himself, and asked if there was somewhere he could read the newspapers without disturbing anyone. The librarian would have unlocked a conference room for him to use.
Denying that he had schizophrenia took effort. His life would have been simpler if he admitted that he had the disorder. If you put more effort into denying that you have a disorder than the treatment would demand, then you have a denial problem.
He asked me whether I thought he was crazy. I said, "You're crazy if you deny that you have a mental illness. If you admit it, then you're not crazy."
You might think that people who are in denial are lazy bums, but look again. My neighbor worked hard, almost every minute of the day, to refuse to believe that he had schizophrenia.
Stutterers who are in denial work harder than stutterers who are open about their stuttering. For example, saying "the great American pastime" instead of "baseball." That's eight syllables instead of two, and some listeners won't know what you're talking about.
The Most Important Aspect of Your Life
I had dinner with an accountant. He worked for a local government. He kept pen and paper next to his bed because he'd wake up with ideas of how to solve accounting problems at work.
My first thought was, this guy needs a life! He dreams about accounting!
Then I thought, he thinks about accounting 24/7. He must be a good accountant. When I need an accountant I'll hire him.
Until I was 22 and saw myself on video, I was unaware how severely I stuttered. I thought that I had a minor speech problem. I tried to do everything that everyone else does. When I failed at things most people seemed to effortlessly achieve (e.g., finding a job or a girlfriend) I didn't realize it was because talking to me was an excruciating experience for listeners. No one told me that. They just avoided me.
When I was 30 I realized that stuttering wasn't something that I could compensate for by excelling at other things. Stuttering affected every aspect of my life. I changed the focus of my life. I thought about stuttering 24/7. I'd wake up with ideas for how to solve speech problems. Speech therapy changed from something I did two hours a week, to what I did all the time.
Whatever you focus on, you can achieve. It may take years of persistence but you will succeed. But you can only think about one thing 24/7. You don't want to spend your life climbing a mountain, get to the top, then see that you climbed the wrong mountain.
Is stuttering the most important aspect of your life? If you're a severe stutterer, as I was, the answer may be yes. Focus on stuttering 24/7. Your speech will improve, and then everything else will fall into place. For example, your speech improves, then your boss gives you a promotion. Then the pretty blonde at the photo store wants to be your girlfriend. It happened to me, and it'll happen to you. Read more stories like this in the article Famous People Who Stutter
But if you're a mild stutterer, stuttering might be the wrong mountain for you to climb. You might be focusing your energy on stuttering, when listeners don't care whether you stutter. They might even like hearing you stutter mildly. Your life isn't going to change until you focus your energy elsewhere.
Freedom to Speak—Badly
I found this in the book How to Learn Any Language:
Americans, however, hold one high card that too frequently goes unplayed. We're gregarious. We're extroverts. Some say it contemptuously. Some say it admiringly. But those who know us best agree that we Americans are the only people in the world who enjoy speaking another language badly!
Most people in the world are shy, embarrassed, even paralyzed when it comes to letting themselves be heard in languages they speak less than fluently. An American may master a foreign language to the point where he considers himself fluent. A European, however, who speaks a language equally well and no better will often deny he speaks it at all! [22]
Are you an American—happy to talk even when your speech isn't good? Or are you a European—"shy, embarrassed, even paralyzed" when you can't speak fluently?
The First Amendment is freedom of speech. Generations of Americans have fought for that right. Stick an American flag pin in your lapel and go out and speak—badly, if you have to.
I found this in an article about Li Yang, the most successful English teacher in China:
He pleads with students to "love losing face.…You have to make a lot of mistakes. You have to be laughed at by a lot of people. But that doesn't matter, because your future is totally different from other people's futures." [23]
Change Your Lifestyle to Talk More
Ask your supervisor to give you work requiring talking. This could be talking to customers, or calling suppliers, or training other employees.
Or change careers to a job that requires talking. A friend bought an Edinburgh Masker, quit his job as a back room accountant at a bank, then worked at the Chicago Board of Trade, yelling orders to buy and sell soybean futures. Now he's a law school professor.
Or find a volunteer service requiring talking. Hospitals have information booths where volunteers direct visitors to their floors. Public television stations need volunteers to answer the phones during pledge drives.
Political groups need canvassers to collect signatures on petitions. Pick a cause you believe in. Imagine yourself standing on a busy street corner, talking to passersby about an important issue. Can you picture anything more American?
And compliment people. Don't limit this to attractive, single persons. Make everyone you meet feel good about themselves. Compliment old men, women pushing strollers in the park, the person behind you in the supermarket line, and your in-laws.
Compliment the person's smile. Then smile. This will make the person smile. Add a little joke such as, "Give my compliments to your orthodontist."
Compliment the person's eyes. This reminds you to make eye contact. Look into the person's eyes long enough to mentally note his or her eye color.
Compliment the person's name. This helps you remember the person's name. Ask how his or her name is spelled (e.g., Rebecca vs. Rebekah), the ethnic origin, or the meaning of the name. Read a history of your area to learn the names of local heroes and historical figures.
Listen for extraordinary things people have done, then reflect this back to them. Everyone thinks that their lives are ordinary. For example, a man who flies jet fighters thinks of himself as an ordinary fighter pilot. Make people feel special and they'll like you whether you stutter or not.
Or tell stuttering jokes. Here's my favorite:
A stutterer goes away to a two-week intensive speech therapy course on the East Coast. When he returns, his friends ask how it went.
The stutterer pauses, takes a deep breath, and slowly says, "Peter Piper picked a peck of pickled peppers."
His friends are amazed. "You said that completely fluently!" they say.
The stutterer says, "Y-y-yeah b-b-but it's, it's h-h-hard t-t-to w-w-work th-that in-t-to a, a c-c-conversation."
References
[1] Bloodstein, O. & Bernstein Ratner, N. A Handbook on Stuttering (2007; ISBN 978-1-4180-4203-5)
[2] Bloodstein, O. & Bernstein Ratner, N. A Handbook on Stuttering (2007; ISBN 978-1-4180-4203-5)
[3] Bloodstein, O. & Bernstein Ratner, N. A Handbook on Stuttering (2007; ISBN 978-1-4180-4203-5)
[4] Bloodstein, O. & Bernstein Ratner, N. A Handbook on Stuttering (2007; ISBN 978-1-4180-4203-5)
[5] Menzies, et al. An Experimental Clinical Trial of a Cognitive-Behavior Therapy Package for Chronic Stuttering, J Speech Lang Hear Res, Dec 2008, 51, 1451-1464.
[6] Bloodstein, O. & Bernstein Ratner, N. A Handbook on Stuttering (2007; ISBN 978-1-4180-4203-5), page 347.
[7] Bloodstein, O. & Bernstein Ratner, N. A Handbook on Stuttering (2007; ISBN 978-1-4180-4203-5), page 347.
[8] Bloodstein, O. & Bernstein Ratner, N. A Handbook on Stuttering (2007; ISBN 978-1-4180-4203-5), page 348.
[9] Bloodstein, O. & Bernstein Ratner, N. A Handbook on Stuttering (2007; ISBN 978-1-4180-4203-5), page 348.
[10] Reitzes, P. Voluntary Stuttering. Advance for Speech-Language Pathologists and Audiologists, Vol. 15, Issue 47, Page 14. http://speech-language-pathology-audiology.advanceweb.com/ Editorial/Search/AView-er.aspx?AN=SP_05nov21_spp14.html&AD=11-21-2005
[11] Reitzes, P. Voluntary Stuttering. Advance for Speech-Language Pathologists and Audiologists, Vol. 15, Issue 47, Page 14. http://speech-language-pathology-audiology.advanceweb.com/ Editorial/Search/AView-er.aspx?AN=SP_05nov21_spp14.html&AD=11-21-2005
[12] Bloodstein, O. & Bernstein Ratner, N. A Handbook on Stuttering (2007; ISBN 978-1-4180-4203-5), page 349.
[13] Bloodstein, O. & Bernstein Ratner, N. A Handbook on Stuttering (2007; ISBN 978-1-4180-4203-5), pages 349-350.
[14] Bloodstein, O. & Bernstein Ratner, N. A Handbook on Stuttering (2007; ISBN 978-1-4180-4203-5), pages 350-51.
[15] Bloodstein, O. & Bernstein Ratner, N. A Handbook on Stuttering (2007; ISBN 978-1-4180-4203-5), page 351.
[16] Bloodstein, O. & Bernstein Ratner, N. A Handbook on Stuttering (2007; ISBN 978-1-4180-4203-5), pages 405-407.
[17] Manning, W. H., Burlison, A. E., & Thaxton, D., (1999) Listener response to stuttering modification techniques. Journal of Fluency Disorders, 24, 267-280.
[18] Blomgren, M., Roy, N., Callister, T., & Merrill, R. Intensive Stuttering Modification Therapy: A Multidimensional Assessment of Treatment Outcomes, Journal Speech Hearing Research, 48:509-523, June 2005.
[19] Mitzman, David. The Right Message. National Stuttering Association conference schedule, June 2006, page 26.
[20] Montgomery, Catherine. Liberating Ourselves as Clinicians: The Care and Feeding of Us and Our Clients. ISAD2006 Online Conference, http://www.mnsu.edu/comdis/isad9/papers/montgomery9.html
[21] De Nil, L., & Kroll, R. The Relationship Between Locus of Control and Long-Term Stuttering Treatment Outcome in Adult Stutterers, Journal of Fluency Disorders, 20:4, December 1995.
[22] Farber, Barry. How to Learn Any Language. 1991, ISBN 0-8065-1271-7, pages 97-98.
[23] Osnos, Evan. Crazy English. The New Yorker, 2008 April 28, page 49.
