درک پدیدارشناختی مدیریت موفق لکنت زبان

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.

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 intervention) 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 stuttering) rather than the term “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). Secondly, 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 surveys or interviews to identify factors associated with success. For example, Wingate (1964) used a structured survey to obtain information from 50 “recovered” persons who stuttered. Wingate's findings identified several factors related to recovery, with changes in attitude (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 support of another person” or to “experiences which encouraged better self-appraisal” (p. 317). Sheehan and Martyn, 1966 and Sheehan and Martyn, 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). The factors identified by Shearer and Williams paralleled the findings of Wingate (1964) and Sheehan and Martyn, 1966 and Sheehan and Martyn, 1970, with greater self-confidence, greater awareness of the problem, and improved relaxation reported as important contributions to recovery. In addition, Shearer and Williams reported that slowing the rate of speech, 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-worth and lessened feelings of helplessness about speech. Participants also described the 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 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 accounts 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 considered by the participants to be better than those strategies that were intuitive on the part of the speaker (e.g., forcing out the speech or avoiding). Crichton-Smith found, as did Corcoran and Stewart (1998), that the key elements of the stuttering experience were suffering, helplessness, 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) employed a structured, open-ended interview technique that examined unassisted 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, environmental 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 indicated 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 spontaneous 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 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. Although these studies provide important information on potential factors associated with recovery, the methods used to collect the data limited the participant's responses 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 individuals 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 phenomenon. 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 and 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 appears 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 studying 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. The primary question to be investigated in this study was: From the perspective of the person who stutters, what is the essential structure of the process that leads to successful management of stuttering? In order to place the process of successful management into perspective, 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?