A Multiprocess Behavioral Approach to Stuttering Therapy

An approach to stuttering therapy based on the several conditioning processes—instrumental, classical, avoidance, and vicarious conditioning —has already been described (Starkweather, 1979a). The basic idea of this approach is that any stuttering behavior may have developed and may still be maintained by any of the major conditioning processes. Further, it is the clinician's job to determine, when possible, the conditioning process maintaining each behavior. A therapy plan can then be prescribed in which a specific deconditioning process is used for each one. Multiprocess behavioral therapy is based on a number of basic principles and premises, which follow: 1. Stuttering has two major components—(a) feelings that arise from the experiences of being a stutterer, and (b) overt stuttering behaviors. The bad feelings (negative emotions) that stutterers have are important because they increase the severity and frequency of stuttering and because they interfere with therapy by making it difficult for stutterers to use newly learned ways of talking in difficult speaking situations. These bad feelings are more common in adult stutterers than in children and more common in older children than in younger ones, although they may in some individuals begin to develop at an early age (Guitar and Peters (1980). Both the feelings and the overt behavior have to be treated. If only the feelings are treated the client is likely to relapse because many of his original overt behaviors remain intact, even though they may be much reduced in severity. When they occur, the stutterer is likely to react to them all over again and become resensitized. Desensitization alone is not enough. Conversely, if only the overt behaviors are treated, there is another danger of relapse. If the fear of being disfluent is still present, normal disfluencies can provoke the old reactions of struggle and avoidance and the relearning of the old overt behaviors. Furthermore, if old fears are left intact, minor setbacks — that is, transient stuttering — can lead to a total breakdown of treatment effects. This two-way path to relapse is closely descr ibed by B a n d u r a (1969) as characteristic of psychologic defensive b e h a v i o r s , w h i c h s h a r e m a n y characteristics with stuttering behaviors (Starkweather, 1973). 2. Stuttering behavior can arise from many different kinds of conditioning processes. This is the basic premise of the eclectic learning theory, or multiprocess behavioral approach. However, continued clinical experience has reconfirmed my original belief that avoidance conditioning is paramount, being responsible for the development of struggle behavior, which is what most stuttering consists of.