Conquering the Shame and the Fear, Then the Syllables

Printed in The New York Times
By Melanie D. G. Kaplan

BOSTON - "Did you do any avoiding behaviors last night?" Adriana DiGrande asked the young men at a conference table at Emerson College. The men, ages 17 to 29, have stuttered since they were children, and in late January, they were wrapping up a four-week program to help them change lifelong habits and feel more confident.

One by one, the students answered Ms. DiGrande's question about avoidance, a term that describes any behavior used by stutterers to deal with their speech disorder. People who stutter often do not answer a ringing phone or order their own meals at restaurants.

"Last night I had to call you, and I was hoping to get your voicemail," said Dan Tichacek, 24, from Wilbraham, Mass., stuttering every few words. "When I heard you answer, I was tempted to hang up, because I hate talking on the phone." Mr. Tichacek was taking time off from his job as an overnight security guard - a shift that does not require much talking - but his dream is to manage a hotel.

Ms. DiGrande told Mr. Tichacek, "O.K., your job today is, if you feel the stuttering, don't run away from it."

Part group therapy, part speech boot camp, the New England Fluency Program teaches students how to use breath, eye contact and timing to improve their fluency. Students also learn about the "pullout," a technique that calmly manages a moment of stuttering rather than pushing forward with words that do not want to come out.

The program is offered several times a year at Emerson and at Boston University, for adults and children. It costs $4,200 and includes six months of weekly follow-up in person. Students are responsible for their own housing and generally pay their own way, with the exception of limited scholarship support or insurance coverage.

When she started the program five years ago, Ms. DiGrande defined success as a 97 percent fluency rate - only three syllables per 100 as stutters - or better by the last day of class. Now, she looks more for a change in attitude.

"Success means confident, comfortable communication," said Ms. DiGrande, a speech pathologist who teaches at Boston University and has been working exclusively with people who stutter since 1982. "The fear of stuttering is the core issue here. Getting through the shame is perhaps the most difficult part, but also the most important."

Stuttering affects 5 percent of children, according to the Stuttering Foundation of America. But 75 to 80 percent of them outgrow their stutter. Of the 1 percent of the population left stuttering, there are about four times as many men as women. And it is common for a child to reach his late teens without ever bringing up the issue with family or friends because of his embarrassment.

On the first day of the program, Ms. DiGrande videotaped each of the participants. Leo Sousa, 29, a severe stutterer who moved to Lowell, Mass., from Brazil two years ago, looked into the camera and talked about his stuttering, in a whispery, stammering voice.

"I get out of breath; I have to open my chest," he said, gesturing with his arms. "It's like not having control." For several years, Mr. Sousa, who has dark curly hair and wears a small silver hoop in his ear, played the guitar in a touring band in Brazil, and he plans to go to Berklee College of Music next year. He says that as an artist, he is full of ideas that he aches to express, but he has always backed out of conversations because of his speech impediment.

Later in the week, Mr. Sousa called some flower shops, stuttering badly: "Hello, my name is Leo, and I stutter. Do you sell long-stemmed roses?" The technique he used, called advertising, forces students to be open about their stuttering. The theory is that once they have declared their stutter, there is no need to hide it or be ashamed of it.

"I believe strongly that one has to change their relationship to stuttering," Ms. DiGrande said. "If we can take the emotional power out of that moment of stuttering - so they can experience it in a calm way - they can actually treat it."

People who stutter also experience fear - not only of stuttering but of a negative response from listeners. In the program, students talk about comments that have been hurtful to them over the years. Mr. Sousa said his father, who died when he was 14, used to be impatient. "I'd say 'v-v-vase,' " he recalled, "and he'd say, 'What is v-v-vase? Just open your mouth and speak.' So I learned to talk less around him."

Ms. DiGrande tells her students that once their speech improves, family members might think it will be stutter-free in the future, an unrealistic expectation. So she teaches them a trick: When someone compliments you on your speech, deliberately stutter through "thank you" so that person realizes that you do not expect your speech to be perfect, nor should they.

Along with making more than 100 phone calls - which are monitored, recorded and evaluated - participants work with Emerson graduate students in speech pathology, using voice monitor machines, and they practice asking for directions at downtown stores. Assignments include writing letters to their stutter and drawing their stutter.

The final assignment of the program is to give a speech. The night before the presentation, Lucas Benedeti, a 17-year-old from Panama City, Panama, called Ms. DiGrande at 10:30 - she often asks students to call her in the evening, for phone practice - and read his three-minute speech on her voicemail.

Before friends and family gathered to hear the students' speeches, Mr. Sousa, whose voice has become louder and stronger, made some practice calls to a limousine company. He asked several questions about rentals, with only one stutter.

"Beautiful!" Ms. DiGrande said, putting her arm on his shoulder.

Mr. Sousa says he never realized speaking could be pleasurable, rather than something to avoid. For the first time, he is enjoying phone conversations. In the past few days, he had talked to his fiancée's aunt, his 6-year-old son and his mother, in Brazil. "She told me, 'Oh, you sound great,' " Mr. Sousa said. "And I said, 'T-t-t-thank you.' "

©2005 The New York Times