2003 IFA Congress: Montreal, Canada

Pauses!? Overcoming Reluctance and Demonstrating Necessity

Peter Toney
National Association Self-help and Initiatives on Stuttering (NASIS),
PO Box 104, I220 Sofia, Bulgaria

SUMMARY

The basic part of our therapy consists of counseling, persuasion and motivating clients to use many pauses in speaking. We combine this instruction with many exercises in different situations and give them the opportunity to practice the skills of (l) differentiating between stuttering blocks and real pauses; and (2) identifying similarities between “long pauses” and natural pauses. Speech style after mastering the use of pauses should appear easier and more fluent than that characterized by moments of tension and stuttering, as in previous utterances. The pauses can serve as a stimulus to reflect on ways to achieve fluent speech.

The use of pauses as part of successful therapy has been investigated for a long time. I have had personal experience with it, as well as observation, assessment and management using pausing in stuttering counseling and therapy with 14 of my clients (in individual and group therapy) in the last two years.

The first reaction of all clients to the suggestion that they make use of longer pauses is reluctance and unwillingness to accept this technique. In fact, I have a problem getting clients to accept even normal pauses of 1-2 seconds. For these clients, 1-2 seconds seems like many years.

The reluctance stutterers have to pausing seems to be associated with the core aspects of stuttering, perhaps an exaggerated feeling of speaking too slowly for the audience/listener, which creates discomfort and unpleasant negative feelings. During assessment, many of them ( ll of 14 clients or 78.6%) shared with me that they had some kind of a guilt about wasting the time of their listeners.

It is paradoxical that, in contrast to the deliberate use of proposed, relaxed pauses of 2-3 seconds, most stutterers during assessment do not appear to realize that they make far longer pauses, filled with blocks, prolongations, repetitions, or meaningless sounds, syllables or words (857%).

In my work, we point out all the possible advantages of using of deliberate pausing and the disadvantages of not doing so. The advantages are:
  • to gain time to relax speech tension
  • to reflect on moments of disfluency in the previous phrase or sentence
  • to consider the next utterance and how to produce it in the best and most fluent way. In
  • this, we consider not only the psychomotor aspect of speech, but the language factors: clear and appropriate morphological, semantic and syntactic structure.
  • to have the time to look at one or more faces in the audience or listeners. This allows audience perception. This may allow the speaker simply to realize that the listener reactions are quite normal, and similar to those they have to all other speakers.
The drawbacks of not using normal pauses include:
  • increased tension and disfluency in the next stages of speaking
  • decreased ability to build the structure of the next sentence or its parts
  • permanent use of substitution, or reducing and cutting off of difficult words as soon as they sense problems, which in turn can create unintended pausing.
The basic part of therapy consists of counseling, persuading and motivating clients to use much longer, intentional pauses. A main goal of therapy is to give them the opportunity to practice this skill through activities which target:
  • differences between stuttering blocks and real pauses
  • similarities between the long pauses and the natural pauses.
  • the concept that pauses are not a part of stuttering, that they are a natural part of fluent speech.
  • that speech after pauses should come more easily than before moments of tension and stuttering as in previous utterances. The pauses can serve as a stimulus to reflect on ways to achieve fluent speech, and are also easily measured by the clinician as an indicator of progress.
We use some specific techniques in the therapy process:

  • learning to feel the diaphragm and mastering its movements for natural relaxation, and upward movement, and learning to stop when it is not necessary to inhale additional air.
  • teaching clients to begin speech and speech flow easily and freely
  • teaching clients not to begin speaking until they have relaxed the diaphragm. The stress is not on the meaning of the text, but on the free starting of vocalized airflow, as a falling leaf. We find that the longer the pause, the less the tension, which can create the basis for light Contact in the initiation of speech in different ten sentences.
These exercises were fulfilled successfully by 12 of 14 clients or 85.71%).

The pauses can be used for some kind of quick checking of the relaxation of the diaphragm and of the entire speech mechanism and its readiness for fluent speech - especially the larynx and mouth cavity. It could be done with a short sigh, by letting out a little air. When we are sure that the diaphragm is relaxed, we are ready for the next part of our utterance. If we do not have relaxation in the diaphragm we could not expect fluent movement and relaxation in the upper part of the speech mechanism.

Another technique which I apply is to wait for the diaphragm to be relaxed after a pause and then to move forwards. Then we produce our speech in a relaxed way.

In the last decades scientists and researchers (Manning, 1996; Peters & Guitar, 1991; Starkweather, 1995) have increasingly concluded that the linguistic side of speech plays a very important role in fluency and disfluency. In my work (and not only in mine) I find, PWS achieve more fluent speech when reading than in their own communication ie. dialogue and monologue. The explanation is simple and logical:
  • In reading we have prepared text - phrases and sentences. It saves us effort and reduces tension in the creating of an idea and linguistic structure.
  • In reading, we have exact and clear punctuation for short and/or long pauses.
But how can we get linguistic “comfort” in our own spontaneous dialogues and monologues? My long practice with pausing suggests that one of the best ways to achieve this comfort is the pause - the well mastered pause (Tonev, l994).By appropriate and well mastered pauses we endeavor to establish the same help and facility as in the punctuation in the written text:
  • In every following utterance there are many different possible ideas, and that makes us hesitate over the best choice. A longer pause is the best way to achieve it.
  • We have always a choice about the best linguistic structure of our utterance, on phonetic, morphological, syntactical, semantic and pragmatic levels. Well mastered pauses give us the opportunity to make the best choice.
  • The level of neuromotor processes - programming and execution - also need to be normalized if in previous utterances there have been moments of disfluent effort and tension. The longer the pauses the better the relaxation of these very important levels of the speech process in stutterers. 148 Theory, research and therapy in fluency disorders
  • By pausing, stutterers can realize and overcome some of the secondary symptoms accompanying stuttering - spasms and grimaces of the face and movements of different parts of the body. The pause gives some necessary time for becoming aware of, correcting and eliminating some or all of them.
  • In the pause, the client can plan the best prosody - which is important. He or she can choose the key word or words to put stress on in his or her utterance.
In the confirmation and stabilization phases of this kind of therapy, we teach clients to practice pauses of different lengths and in different situations, with different audiences, to overcome the tendency to tighten the speaking muscles ( Starkweather, 1995), hold the breath, or any another counterproductive measure that interferes with the ability to communicate.

We also demonstrate pauses for clients, using recordings of politicians, public personalities and film and sports stars. Theirspeech seems normal and attractive even though they use long, even very long, pauses, according 9 of 14 stutterers or 64.28%. Stutterers simply have to realize that using long pauses in speech should be considered as normal and effective.

We feel that longer pauses influence and help stutterers to learn a new attitude toward speech, and toward audience reactions, as well as a new style of communication and a way to escape some old habits supporting stuttering.

Each of these complex activities are worked on and mastered in small steps. After treatment, 10 of 14 clients or 71.42% accepted to use pauses in their speech, convinced in their positive effect. Speech is the most complex human activity and stuttering, as its disorder, requires the use of different methods used in small and deliberate steps. On such method is to work on pauses.

References

Manning, W. H. (1996), Clinical decision making in the diagnosis and treatment of fluency disorders. Albany, NY: Delmar.

Peters, T. J ., & Guitar, B. (1991), Stuttering.”˜ An Integrated approach to its nature and treatment. Baltimor, MD: Williams & Wilkins.

Starkweather, C. W. (1995), A simple theory of stutering, Journal of Fluency Disorders, 20, 91-116.

Starkweather, C. W. (1987), Fluency and stuttering, Englewood Clifts, NJ: Prentice-Hall.

Tonev, P. (1994), Speech control, correction, and overcoming stuttering: A solution by perfectly mastered breathing (PMB). Procedings of the First World Congress of Fluency Disorders in Munich, Germany (pp. 367-69), Nijmegen: Nijmegen University Press.

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